Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study

Abstract

Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Bone Mineral Density Changes in Long-Term Kidney Transplant Recipients: A Real-Life Cohort Study of Native Vitamin D Supplementation

“…Notably, the most common diagnosis was osteopenia both at the right femoral neck (54.1%) and at the lumbar vertebral bodies (43.3%). These results are consistent with previous studies [20][21][22] in which the prevalence of low BMD ranged from 49% to 80% in KTR cohorts depending on type of KT donor (living or deceased), the median time since KT (from 8 to 130 months), the length of follow-up (up to 2 years), and other demographic characteristics. Similarly, in a recent study by Jorgensen and coworkers, osteoporosis was detected in 46% (with the highest prevalence at the distal skeleton) of 141 unselected KTR who underwent a bone biopsy one year after transplantation, and this finding was independent of the type of bone turn-over abnormality [23].…”

Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

“…The study design was cross-sectional in 27 studies [ 11 , 12 , 14 , 15 , 18 – 21 , 23 – 32 , 34 – 37 , 41 – 45 ] (71.1%) and longitudinal in 11 [ 13 , 16 , 17 , 22 , 33 , 38 – 40 , 46 – 48 ] (28.9%). All these articles were published between 2001 and 2021, and most of them were conducted in Europe [ 13 , 14 , 16 , 19 – 24 , 29 – 31 , 35 , 36 , 38 , 39 , 42 ] (44.7%), although there were also studies from Asia [ 11 , 18 , 25 – 27 , 34 , 37 , 40 , 43 , 45 , 46 , 48 ] (31.6%), America [ 15 , 17 , 28 , 32 , 33 , 44 , 47 ] (18.4%) and Oceania [ 12 , 41 ] (5.3%).…”

Fracture Risk In Chronic Kidney Disease Patients

“…При изследването на 153 болни с бъбречна трансплантация на средна възраст от 46,5±11,9 г. се установява честота на фрактура на прешлените от 43,4% (22). Съгласно резултатите от мултивариационния анализ единствено приложението на кортикостероидни препарати е свързано с риск за тази фрактура (отношение на шансовете от 0,121; между 0,015 и 0,988 при доверителен интервал от 95%; р=0,049).…”