Treatment of osteopenia and osteoporosis in renal transplant children and adolescents

El-Husseini, Amr; El‐Agroudy, Amgad E.; El‐Sayed, Moharam; Sobh, Mohamed; Ghoneim, Mohamed A.

doi:10.1111/j.1399-3046.2004.00191.x

Cited by 60 publications

(57 citation statements)

References 30 publications

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“…Calcitriol can also prevent bone loss especially during the first year after trans plantation [76,77] . Similar to calcitriol, oral alfacalcidol can lower PTH and improve BMD in KT recipients [78,79] . In these studies, transient hypercalcemia occurred in a few patients but all incidences were without clinical significance.…”

Section: Vitamin Dmentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

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Section: Vitamin Dmentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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“…The majority of subjects showed increased BMD or reduced bone pain [21,38,39,40,41,42,43,44,45,46,47,48]; a reduced fracture rate was reported in patients with quadriplegic cerebral palsy [48]. …”

Section: Bisphosphonate Use In Pediatric Patientsmentioning

confidence: 99%

The Use of Bisphosphonates in Pediatrics

Baroncelli

Bertelloni

2014

Horm Res Paediatr

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Bisphosphonates are widely used for the prevention and treatment of osteoporosis in adulthood. In the last years, bisphosphonates have been increasingly used in pediatric patients for the treatment of a growing number of disorders associated with osteoporosis, resistant hypercalcemia or heterotopic calcifications. The use of bisphosphonates in pediatric patients has been proven safe; however, the risk of potential severe consequences into adulthood should be kept in mind. Well-defined criteria for bisphosphonates treatment in pediatric patients are not specified, therefore an accurate selection of patients who could benefit from bisphosphonates is mandatory. A strict follow-up of pediatric patients receiving long-term bisphosphonate therapy is strongly recommended. The purpose of this mini review is to provide a summary of current knowledge on some main general aspects of the structure, mechanisms of action, pharmacokinetics, and bioavailability of bisphosphonates, and to focus on the latest advances of bisphosphonate treatment in pediatric patients. Particular attention has been paid to the common and potential adverse effects of bisphosphonate treatment, and some suggestions concerning the clinical approach and general measures for bisphosphonate treatment in pediatric patients are reported.

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“…[3][4][5][6][7][8][9][10][11] DXA is a projection technique that summarizes total bone mineral content within the projected bone area, resulting in two important limitations in childhood CKD. First, trabecular and cortical bone are superimposed, potentially concealing the opposing effects of elevated parathyroid hormone (PTH) levels to increase and decrease trabecular and cortical bone mineral content, respectively.…”

mentioning

confidence: 99%

Bone Density and Cortical Structure after Pediatric Renal Transplantation

Terpstra

Kalkwarf²,

Shults³

et al. 2012

Journal of the American Society of Nephrology

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The impact of renal transplantation on trabecular and cortical bone mineral density (BMD) and cortical structure is unknown. We obtained quantitative computed tomography scans of the tibia in pediatric renal transplant recipients at transplantation and 3, 6, and 12 months; 58 recipients completed at least two visits. We used more than 700 reference participants to generate Z-scores for trabecular BMD, cortical BMD, section modulus (a summary measure of cortical dimensions and strength), and muscle and fat area. At baseline, compared with reference participants, renal transplant recipients had significantly lower mean section modulus and muscle area; trabecular BMD was significantly greater than reference participants only in transplant recipients younger than 13 years. After transplantation, trabecular BMD decreased significantly in association with greater glucocorticoid exposure. Cortical BMD increased significantly in association with greater glucocorticoid exposure and greater decreases in parathyroid hormone levels. Muscle and fat area both increased significantly, but section modulus did not improve. At 12 months, transplantation associated with significantly lower section modulus and greater fat area compared with reference participants. Muscle area and cortical BMD did not differ significantly between transplant recipients and reference participants. Trabecular BMD was no longer significantly elevated in younger recipients and was low in older recipients. Pediatric renal transplant associated with persistent deficits in section modulus, despite recovery of muscle, and low trabecular BMD in older recipients. Future studies should determine the implications of these data on fracture risk and identify strategies to improve bone density and structure. During childhood and adolescence, skeletal development is characterized by increases in trabecular and cortical bone mineral density (BMD) and cortical dimensions. 1 Children with CKD have numerous risk factors for impaired bone acquisition, including growth failure, delayed puberty, malnutrition, acidosis, vitamin D deficiency, muscle deficits, and secondary hyperparathyroidism. Successful renal transplantation corrects many of the underlying abnormalities contributing to bone deficits in childhood CKD. However, immunosuppressive therapies and persistent hyperparathyroidism may impair recovery of bone structure and strength. The risk of fracture among adult renal transplant recipients increases in the months after transplantation and then gradually declines. 2 The

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Treatment of osteopenia and osteoporosis in renal transplant children and adolescents

Cited by 60 publications

References 30 publications

Mineral and bone disorder after kidney transplantation

Mineral and bone disorder after kidney transplantation

The Use of Bisphosphonates in Pediatrics

Bone Density and Cortical Structure after Pediatric Renal Transplantation

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