Lumbar bone mineral density in very long-term renal transplant recipients: Impact of circulating sex hormones

Brandenburg, Vincent; Ketteler, Markus; Heussen, Nicole; Politt, Dirk; Frank, Rolf Dario; Westenfeld, Ralf; Ittel, T. H.; Floege, Jürgen

doi:10.1007/s00198-005-1884-6

Cited by 35 publications

(22 citation statements)

References 32 publications

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“…Nevertheless, recent data that were obtained from patients between 6 and 20 yr after renal transplantation showed a mean annual decrease in lumbar T scores of Ϫ0.6 Ϯ 1.9%, a value that is relatively similar to the observed decline in the general population with aging. The mean annual BMD loss was statistically indistinguishable between men and women, but low estradiol levels were associated with accelerated bone loss (6).…”

Section: Changes In Bone Mineral Densitymentioning

confidence: 80%

Bone Disease after Renal Transplantation

Weisinger¹,

Carlini²,

Rojas³

et al. 2006

Clinical Journal of the American Society of Nephrology

125

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It has been well established that a rapid decrease in bone mineral density (BMD) occurs in the first 6 to 12 mo after a successful renal transplantation and persists, albeit at a lower rate, for many years. This rapid BMD loss significantly increases the fracture risk of these patients to levels that are even higher than those of patients who have chronic kidney disease stage 5 and are on dialysis. The presence of low BMD in renal transplant patients as a predictor of risk fracture is controversial. Indeed, as has been suggested also for patients with postmenopausal osteoporosis, there is not a compelling correlation between the decline in BMD and skeletal fractures. However, bone disease after renal transplantation probably represents a unique bone disorder that must encompass underlying renal osteodystrophy. In fact, this syndrome results from multiple factors that include pretransplantation bone status, use of glucocorticoids and other immunosuppressive drugs, hypophosphatemia, and alterations of the calcium-vitamin D axis. Recent studies have demonstrated decreased osteoblast number, reduced bone formation rate, delayed mineralization, and increased osteoblast and osteocyte apoptosis. Bisphosphonates and vitamin D metabolites may be valuable in preventing or diminishing early bone loss. However, clinicians should be careful with the use of bisphosphonates and oversuppression of bone, especially in patients with low bone turnover. New prospective, controlled trials are required to confirm the real efficacy of these drugs, particularly in long-term renal transplant patients.Clin J Am Soc Nephrol 1: 1300 -1313, 2006. doi: 10.2215/CJN.01510506 K idney, heart, lung, and liver transplantation have become fairly common and successful. As the number of transplants has grown, new challenges have arisen in the management of long-term complications of transplantation. Posttransplantation bone disease represents one such important complication, because it is observed in a substantial proportion of patients. As a consequence, bone mass loss and bone fractures are common in these patients and cause substantial morbidity.In patients with chronic kidney disease (CKD), renal osteodystrophy that begins during the early stages of the disease usually worsens during dialysis and may persist after transplantation, although in many patients, improvement in these bone lesions are observed. In addition to preexisting bone lesions, not only factors that hamper recovery but also new factors could affect bone structure after transplantation. These include the potential deleterious effects on bone of the different immunosuppressive agents, the impaired renal function that frequently is observed in renal transplant patients, and several others factors that are particular to each patient, such as postmenopausal status, presence of diabetes, gender, and time after transplantation. Changes in Bone Mineral DensityBone mineral density (BMD) as assessed by dual x-ray absorptiometry has been used as a noninvasive method to assess bone mass loss...

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Section: Changes In Bone Mineral Densitymentioning

confidence: 80%

Bone Disease after Renal Transplantation

Weisinger¹,

Carlini²,

Rojas³

et al. 2006

Clinical Journal of the American Society of Nephrology

125

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“…Low bone mineral density (BMD; T score <–2.5) was frequently diagnosed in kidney transplant patients [24, 25,34,35,36,37,38,39,40,41]. Averaging all data, the percent of patients with low BMD from primarily cortical bone sites was greater than that from primarily trabecular bone sites (fig.…”

Section: Resultsmentioning

confidence: 99%

Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

et al. 2007

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Background/Aims: Abnormal bone and mineral metabolism is common in patients with kidney failure and often persists after successful kidney transplant. Methods: To better understand the natural history of this disease in transplant patients, we reviewed the literature by searching MEDLINE for English language articles published between January 1990 and October 2006 that contained Medical Subject Headings and key words related to secondary or persistent hyperparathyroidism and kidney transplant. Results: Parathyroid hormone levels decreased significantly during the first 3 months after transplant but typically stabilized at elevated values after 1 year. Calcium tended to increase after transplant and then stabilize at the higher end of the normal range within 2 months. Phosphorus decreased rapidly to within or below normal levels after surgery and hypophosphatemia, if present, resolved within 2 months. Low levels of 1,25(OH)₂ vitamin D typically did not reach normal values until almost 18 months after transplant. Conclusion: This review provides evidence demonstrating that abnormal bone and mineral metabolism exists in patients after kidney transplant and suggests the need for treatment of this condition. However, better observational and interventional research is needed before advocating such a treatment guideline.

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“…The decline in both hormones may contribute to the favorable long-term effect of surgery on the risk of breast cancer [19,20] . However, the positive health effect may occur at the expense of an increased risk of osteoporosis and decreased sexual desire [21][22][23] . In summary, prophylactic oophorectomy may protect against breast cancer risk, not only through lowered estradiol but also through lowered testosterone levels after surgery.…”

Section: Discussionmentioning

confidence: 99%

Estradiol and Testosterone Levels Are Lower after Oophorectomy than after Natural Menopause

Korse¹,

Bonfrèr²,

Beurden³

et al. 2009

Tumor Biol

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Objective: The aim of this study was to compare hormone levels between women who became postmenopausal after a prophylactic bilateral salpingo-oophorectomy, and women who became postmenopausal in a natural way. Methods: In this cross-sectional study, we investigated estradiol, testosterone, SHBG, IGF-1 and IGFBP-3 levels in 35 surgically and 40 naturally postmenopausal women. Results: Serum samples were drawn at a mean age of 45.9 years for women with surgical menopause and at 56.5 years for women with natural menopause. Mean estradiol levels declined 1.4 pmol/l per year in both menopausal groups, however, at an 11.1 pmol/l lower level for women with surgical menopause. Testosterone levels of naturally postmenopausal women remained stable at a level of 0.89 nmol/l, while testosterone levels of the surgically postmenopausal women declined 0.04 nmol/l per year. Conclusions: For IGF-1, IGFBP-3 and SHBG, no differences were found between surgically and naturally postmenopausal women. Lower estradiol levels of surgically as compared to naturally postmenopausal women seem to be fully explained by the earlier onset of menopause in combination with the same age-related decrease. However, a decrease in testosterone levels seems to occur in oophorectomized women only, suggesting postmenopausal activity of ovaries in situ.

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Lumbar bone mineral density in very long-term renal transplant recipients: Impact of circulating sex hormones

Cited by 35 publications

References 32 publications

Bone Disease after Renal Transplantation

Bone Disease after Renal Transplantation

Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

Estradiol and Testosterone Levels Are Lower after Oophorectomy than after Natural Menopause

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