Bone mineral density in patients with end-stage renal disease and its evolution after kidney transplantation

Abstract

Renal transplantation is associated with abnormalities of the structure and function of the musculoskeletal system. No data are available on bone health in Indian patients with end-stage renal disease (ESRD) and its evolution after transplantation. Consecutive ESRD patients who underwent living donor renal transplantation were studied prospectively. Bone mineral density (BMD) was measured at lumbar vertebrae using quantitative computed tomography (CT) scan before transplantation and after 3 and 6 months. T and Z scores were calculated by comparing with normal control data, and values were correlated with various clinical and biochemical parameters. Of the 56 patients enrolled (mean age, 33.7 years; 47 males), 40 completed the 6-month follow-up. The vertebral trabecular bone density at the time of transplantation was 172±53 mg/cc and the average Z score was 0.26±1.7. There was a significant decline in BMD at 3 months (11.8%; P<0.0001) and 6 months (16%; P<0.0001) after transplantation. Both T and Z scores showed a significant decline at 3 and 6 months. There was a significant decline in intact parathormone (iPTH) levels after transplantation, but 15 (37.5%) patients continued to have raised iPTH 6 months after transplantation. The iPTH levels at 6 months had significant correlation with BMD decline (r=0.43, P=0.006). We conclude that Indian ESRD patients have relatively well-preserved BMD, but the density declines rapidly after transplantation. A significant proportion of patients exhibit persistent hyperparathyroidism 6 months after transplantation, which correlates with bone loss.

Early steroid withdrawal has a positive effect on bone in kidney transplant recipients: a propensity score study with inverse probability-of-treatment weighting

“…In an Indian study, there was a significant post-transplantation decrease in lumbar spine BMD at 3 months (11.8%, p < 0.0001) and 6 months (16%, p < 0.0001). 47 In a study in the United States, Julian et al reported bone losses of 6.8 ± 5.6% and 8.8 ± 7.0% at the lumbar spine respectively 6 and 18 months after transplantation. 16 Similar losses have been observed at the hip 5 months after kidney transplantation.…”

Noninvasive assessment of bone health in Indian patients with chronic kidney disease

“…In a previous study where BMD was measured using quantitative CT scan (qCT) of lumbar vertebrae, we found the prevalence of osteopenia and osteoprosis to be 23% and 5%, respectively. [33] This difference can be explained by differences in technique and site of study. DEXA measures surface BMD mostly at cortical sites, whereas QCT being a three-dimensional measurement can selectively target the trabecular bone.…”

Indian commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation, and treatment of chronic kidney disease-mineral and bone disorders

“…However, because of perceived differences in clinical behavior, differences in dietary habits, financial issues, and a knowledge gap in the nephrology community, it was felt that certain issues might need to be emphasized or elaborated to ensure that the implementation of the guidelines is not felt to be difficult or even impossible by the ordinary nephrologists or physicians. The group also recognized the paucity of data in Indian subjects,[ 9 – 11 ] and the need to support endeavors that would help generate good quality evidence that specifically addresses clinical issues that might be of greater relevance to Indian patients.…”

“…Quantitative computed tomography (QCT) is probably more specific in terms of assessing bone density than DEXA. [ 9 ] So, in situations where a need for BMD testing is felt, QCT should be preferred over DEXA.…”

“…In view of some Indian data that shows decline in BMD in the first six months after transplant, BMD may be monitored for 6-12 months post transplant. [ 9 ]…”