Prevalence of low trauma fractures in long-term kidney transplant patients with preserved renal function

Abstract

We evaluated the prevalence of low bone mineral density (BMD) and osteoporotic fractures in kidney transplantation (KT) patients and determined risk factors associated with osteoporotic fractures. The study was conducted on 191 patients (94 men and 97 women) with first KT for 3 years or more presenting stable and preserved renal function (serum creatinine levels lower than 2.5 mg/dl). KT patients were on immunosuppressive therapy and the cumulative doses of these drugs were also evaluated. BMD was determined by dual-energy X-ray absorptiometry at multiple sites (spine, femur and total body). Quantitative ultrasound of the calcaneus (broadband ultrasound attenuation, speed of sound, and stiffness index, SI) was also performed. Twenty-four percent (46) of all patients had either vertebral (29/46) or appendicular (17/46) fractures. We found osteoporosis and osteopenia in 8.5-13.4 and 30.9-35.1% of KT patients, respectively. Women had more fractures than men. In women, prevalent fractures were associated with diabetes mellitus [OR = 11.5, 95% CI (2.4-55.7)], time since menopause [OR = 3.7, 95% CI (1.2-11.9)], femoral neck BMD [OR = 1.99, 95% CI (1.4-2.8)], cumulative dose of steroids [OR = 1.1, 95% CI (1.02-1.12)] and low SI [OR = 1.1, 95% CI (1.0-1.2)]. In men, fractures were associated with lower lumbar spine BMD [OR = 1.75, 95% CI (1.1-2.7)], lower SI [OR = 1.1, 95% CI (1.03-1.13)], duration of dialysis [OR = 1.3, 95% CI (1.13-2.7)], and lower body mass index [OR = 1.24, 95% CI (1.1-1.4). Our results demonstrate high prevalence of low BMD and osteoporotic fractures in patients receiving a successful kidney transplant and indicate the need for specific intervention to prevent osteoporosis in this population.

Can DXA Predict Fractures in Renal Transplant Patients?

“…Hazard tients who had suffered fractures than in those who had not (6), but studies where patients have been followed after DXA are lacking. (4)(5)(6)10,11,13,14,23,24 (1,5,6,11,23). In our analysis a diagnosis of diabetic nephropathy more than doubled the risk of fracture.…”

“…Renal transplant patients have an increased prevalence of osteopenia and osteoporosis (1)(2)(3)(4)(5)(6)(7)(8) and an increased risk of fractures (3)(4)(5)(6)(9)(10)(11)(12)(13)(14). This is partly a consequence of previous renal failure with hyperparathyroidism, vitamin D deficiency, acidosis, aluminum toxicity and inactivity (15)(16)(17)(18).…”

Trauma to transplanted kidney with open fractures: Report of a case

“…Following transplantation, use of chronic immunosuppression continues to cause osteoporosis [10][11]. Therefore, spontaneous fractures or tend to easy fracture are expected following all solid organ transplantations [11][12][13][14].…”

Distúrbio mineral e ósseo após o transplante renal

“…A incidência de fraturas entre os pacientes transplantados varia de 7% a 24%, com um risco de fraturas cinco vezes maior que na população geral, sendo até 23 vezes maior quando analisada a coluna vertebral. [42][43][44] É bem estabelecida a associação de osteoporose e risco de fraturas, detectada pela DEXA, em pacientes menopausadas, em uso de corticoides e em outros transplantados, como de coração e fígado. Entretanto, essa associação não é verdadeira para o transplantado renal, visto que a doença óssea pós-TxR é dependente da persistência dos DMO, do período dialítico e da função do enxerto.…”