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Calmarza P, Sanz Paris A, Berrozpe-Villabona C, Gallego Royo A, Domingo Morera JA, Viñuales Aranda MD. [Bone metabolism in patients evaluated for lung transplantation]. NUTR HOSP 2024; 41:594-601. [PMID: 37929858 DOI: 10.20960/nh.04845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Introduction Introduction: the prevalence of osteoporosis among candidates for lung transplantation is high and its pathophysiology is multifactorial. Objectives: to evaluate differences in bone mineral density, risk of fractures and bone remodeling markers in patients with terminal lung disease, at the time they are evaluated for lung transplantation, comparing two types of pathologies. Material and methods: fifty-nine subjects, proposed to receive a lung transplant due to advanced lung disease, were included in this study. They were divided into two groups according to their respiratory pathology: chronic obstructive pulmonary disease (COPD) and diffuse interstitial pulmonary disease (ILD). Demographic data were collected and bone densitometry, blood analysis with markers of bone remodeling, spirometry, six-minute walk test (6MWT), echocardiography and cardiac catheterization were performed Results: no differences were found between the groups, regarding their age, sex, BMI or exposure to tobacco. A higher prevalence of osteoporosis and a higher FRAX were observed in the group with COPD. Regarding bone remodeling markers, higher parathyroid hormone (PTH) and higher osteocalcin were found in the COPD group. Vitamin D was lower in COPD patients. Conclusions: two out of three of the patients evaluated for lung transplantation had osteopenia or osteoporosis. The prevalence of osteoporosis and FRAX is higher in COPD patients. Vitamin D supplementation should be considered in certain patients. Differences in bone remodeling markers may be useful for suspected osteoporosis and therapeutic management.
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Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica. Hospital Universitario Miguel Servet. CIBERCV. Universidad de Zaragoza
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Deng J, Moskalyk M, Hou W, Zuo QK, Luo J. Pharmacological prevention of bone loss and fractures following solid organ transplantations: Protocol for a systematic review and network meta-analysis. PLoS One 2024; 19:e0302566. [PMID: 38669283 PMCID: PMC11051654 DOI: 10.1371/journal.pone.0302566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Solid organ transplant (SOT) recipients can experience bone loss caused by underlying conditions and the use of immunosuppressants. As a result, SOT recipients are at risk for decreased bone mineral density (BMD) and increased fracture incidences. We propose a network meta-analysis (NMA) that incorporates all available randomized control trial (RCT) data to provide the most comprehensive ranking of anti-osteoporotic interventions according to their ability to decrease fracture incidences and increase BMD in SOT recipients. METHODS We will search MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL and CNKI for relevant RCTs that enrolled adult SOT recipients, assessed anti-osteoporotic therapies, and reported relevant outcomes. Title and full-text screening as well as data extraction will be performed in-duplicate. We will report changes in BMD as weighted or standardized mean differences, and fracture incidences as risk ratios. SUCRA scores will be used to provide rankings of interventions, and quality of evidence will be examined using RoB2 and CINeMA. DISCUSSIONS To our knowledge, this systematic review and NMA will be the most comprehensive quantitative analysis regarding the management of bone loss and fractures in SOT recipients. Our analysis should be able to provide physicians and patients with an up-to-date recommendation for pharmacotherapies in reducing incidences of bone loss and fractures associated with SOT. The findings of the NMA will be disseminated in a peer-reviewed journal.
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Affiliation(s)
- Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Myron Moskalyk
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wenteng Hou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Qi Kang Zuo
- UBC Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jinyu Luo
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Santos Monteiro S, Silva Santos T, Pereira CA, Duarte DB, Silva F, Martins LS, Dores J. Bone mineral density progression following long-term simultaneous pancreas-kidney transplantation in type-1 diabetes. ANNALES D'ENDOCRINOLOGIE 2023:S0003-4266(23)00036-7. [PMID: 36931500 DOI: 10.1016/j.ando.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney transplantation (SPKT) has demonstrated favorable impact on the progression of chronic complications in type-1 diabetes (T1D) and terminal chronic kidney disease (CKD). However, some CKD mineral and bone disorders (CKD-MBD) may persist, even after transplantation. There are only a few studies addressing the long-term progression of bone mineral density (BMD) in these patients. Our aim was to assess baseline BMD and long-term progression and consequences in patients with T1D undergoing SPKT. METHODS A retrospective cohort included patients undergoing SPKT in our tertiary center between 2000 and 2017. BMD progression was assessed on dual X-ray absorptiometry (DXA). Only patients with baseline data and a minimum follow-up of 2 years were included. RESULTS Seventy-three patients were included, 53.4% male, with a median age at SPKT of 35 years (interquartile range [IQR] 31; 39). At transplantation, the median T-scores for the lumbar spine (LS) and femoral neck (FN) were -1.6 (IQR -2.6; -1.1) and --2.1 (IQR -2.7; -1.6), respectively. Seventy-five percent of patients presented low BMD (osteopenia or osteoporosis) in the LS and 90% in the FN, with 33% osteoporosis in the LS and 36% in the FN. On multivariate analysis, male gender (odds ratio [OR] 10.82, 95% confidence interval (CI) 2.88-40.70) and low body-mass index (BMI) (OR 0.73, 95% CI 0.55-0.97) were significantly associated with lumbar but not femoral osteoporosis. At long-term follow-up, BMD significantly improved in the LS (ΔT-score +0.41, P<0.001) and FN (ΔT-score +0.29, P=0.01), at a median 4 years after SPKT. Twelve (16.4%) and 9 (12.3%) patients showed persistent FN and LS osteoporosis, respectively. Multivariate linear regression showed that high BMI was predictive of improvement in BMD. CONCLUSIONS This study demonstrated severe skeletal fragility in T1D patients with terminal CKD undergoing SPKT, more than a quarter of whom showed osteoporosis. The significant improvement in BMD may result from metabolic correction by SPKT and from physiological skeleton mineralization, which continues in this age group. BMD progression was positively associated with BMI, due to improved nutritional balance after transplantation.
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Affiliation(s)
- Sílvia Santos Monteiro
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal.
| | - Tiago Silva Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
| | - Catarina A Pereira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
| | - Diana B Duarte
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
| | - Filipa Silva
- Division of Nephrology and Transplant, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
| | - La Salete Martins
- Division of Nephrology and Transplant, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
| | - Jorge Dores
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar 4099-001 Porto, Portugal
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Varatharaj S, Senthil T, Viswanathan VK, Sakthivelnathan V, Mounasamy V, Sambandam S. Complications, demographics and hospital stay in organ transplant patients undergoing total hip arthroplasty - A national database study between 2016 and 2019. J Orthop 2022; 34:221-225. [PMID: 36104995 PMCID: PMC9464784 DOI: 10.1016/j.jor.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022] Open
Abstract
Background The purpose of this study was to analyze the post-operative complications following THA in organ transplant patients; and compare the outcome with general population undergoing THA. Methods and materials In this retrospective study using the National Inpatient Sample (NIS) database, 813 cases of THA (both primary and revision THA) in organ transplant patients (OT) were reviewed. ICD-10 codes were used to assess post-operative variables including the length of stay, cost of care, medical and surgical complications among OT patients undergoing THA. A comparison of all these variables was made with the non-OT (NOT) control population. Results Among 367,894 patients undergoing THR between 2016 and 2019 on NIS database, 813 were OT patients. There was significantly greater proportion of males in the OT group (p < 0.001). Patients in the OT group were also significantly younger (mean age: 61.08 ± 11.95 in OT versus 65.87 ± 11.39 years in NOT; p < 0.001). The OT group had significantly higher prevalence of anemia (p < 0.001), acute renal failure (ARF; p < 0.001), and transfusion rates (p < 0.001). The OT patients also had significantly greater dislocation rates (p = 0.010), wound dehiscence (p = 0.03) and deep surgical-site infections (SSI; p = 0.002). The mean length of hospital stay (3.55 ± 4.89 days in OT vs 2.32 ± 2.52 days in NOT; p < 0.001), cost of care ($82,567.89 ± 74,505.54 vs $66,845.18 ± 47,761.39 for OT and NOT groups, respectively; p < 0.001) and mortality (p = 0.04) were significantly greater in the OT population, as compared to controls. Conclusion Organ transplant patients have significantly greater risk for developing post-operative complications like anemia, ARF, need for higher transfusion rates, prosthetic dislocations, wound dehiscence, and deep SSI following THA. The length of stay, total expenditure incurred and mortality were also higher in OT patients undergoing THA.
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Affiliation(s)
| | | | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, Dallas, TX, USA
| | - Senthil Sambandam
- University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, TX, USA
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Denosumab treatment for osteopenia or osteoporosis in heart transplant recipients: Effects and safety. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Shi Y, Dan Z, Tao Z, Miao Q, Chang T, Zhang X, Jiang X, Li X. The translation and validation of the Organ Transplant Symptom and Well-Being Instrument in China. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000718. [PMID: 36962583 PMCID: PMC10021454 DOI: 10.1371/journal.pgph.0000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
To translate the Organ Transplant Symptom and Well-Being instrument (OTSWI) into Chinese and test the reliability and validity of the Chinese version. A total of 259 patients with organ transplants were recruited from The First Affiliated Hospital of China Medical University in Shenyang, from November 2020 to January 2021. Construct validity was evaluated using exploratory factor analysis (EFA) and reliability were assessed using test-retest reliability and internal consistency. The Cronbach's α of the Chinese version of the Organ Transplant Symptom and Well-being instrument was 0.93. EFA demonstrated that 80.785% of the total variance was explained by a seven-factor solution. The criterion validity of the SF-36 was -0.460 (p < .01), while the test-retest reliability was 0.710. The Chinese version of the OTSWI questionnaire is a valid and reliable instrument for assessing the quality of life of organ transplant patients for symptoms and well-being in China.
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Affiliation(s)
- Ying Shi
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
| | - Zhang Dan
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Zijun Tao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Qi Miao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Tiantian Chang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xu Zhang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaoyu Jiang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaofei Li
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
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Afifi MK, Kenawy AS, El Demellawy HH, Azouz AA, Al-Otaibi T, Gheith O, ElMonem MA, AbdElhalim MS, Hussein RRS. Optimization of osteoporosis and osteopenia management among renal transplant recipients. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Osteoporosis and osteopenia occur frequently in renal transplant recipients due to long-term use of immune-suppressants including corticosteroids. Previous treatment options like bisphosphonates had acceptable but rather unsatisfactory results after transplant. The aim of the current study is to directly compare the efficacy of denosumab and oral ibandronate in late RTR with low bone mineral density.
Results
The study was conducted Iin Hamed Al-Essa Kidney transplant center, Kuwait, in 2020. The data of 52 denosumab and 48 ibandronate patients were collected at the baseline and after one year of treatment. Spine and hip T-score readings, side effects, and other laboratory results were analyzed to evaluate the use of both medications. The mean number of months after transplant was 25 (± 13.9) months. After one year of treatment, denosumab alleviated both spinal osteoporosis and osteopenia T-score values from −3.13 to −2.4 (p = 0.008) and from −1.9 to −1.5 (p = 0.015), respectively. Besides, it reduced hip osteoporosis and osteopenia insignificantly from −3.45 to −3.1 and from −1.5 to −1.3, respectively (p > 0.05). Ibandronate improved spinal osteopenia from −1.6 to −1.55 (p = 0.97) and failed to show any positive impact on other sites; the spinal osteoporosis changed from −2.8 to −3 and hip osteoporosis and osteopenia changed from −3.1 to −3.12 and from −1.4 to −1.45, respectively (p > 0.05). The use of ibandronate was more associated with gastrointestinal tract (GIT) side effects, while hypocalcemia episodes were significantly higher in the denosumab group.
Conclusion
Denosumab improved both spinal and hip T-score values in comparison with ibandronate in RTR. Close monitoring is required for denosumab patients to prevent the associated hypocalcemia.
Graphical Abstract
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Whitsett M, Serper M. Exercise Interventions for Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION Liver transplantation is a life-changing event for patients and survival following transplantation has improved significantly since the first transplantation in 1967. Following liver transplantation, patients face a unique set of healthcare management decisions including transplantation-specific complications, recurrence of primary liver disease, as well as metabolic and malignancy concerns related to immunosuppression. As more patients with liver disease receive transplantation and live longer, understanding and managing these patients will require not only transplant specialist but also local subspecialist and primary care physicians. AREAS COVERED This review covers common issues related to the management of patients following liver transplantation including immunosuppression, liver allograft dysfunction, metabolic complications, as well as routine health maintenance such as immunizations and cancer screening. EXPERT OPINION Optimizing medical care for patients following liver transplant will benefit from ensuring all providers, not just transplant specialist, have a basic understanding of the common issues encountered in the post-transplant patient. This review provides an overview of common healthcare concerns and management options for patients following liver transplantation.
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Affiliation(s)
- Nicholas Hoppmann
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham , Birmingham, Alabama, USA
| | - Omar Massoud
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham , Birmingham, Alabama, USA
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Caffarelli C, Tomai Pitinca MD, Alessandri M, Cameli P, Bargagli E, Bennett D, Fossi A, Bernazzali S, Gonnelli S. Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study. J Clin Med 2020; 9:jcm9092941. [PMID: 32933025 PMCID: PMC7565939 DOI: 10.3390/jcm9092941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
Bone loss and bone fractures are common complications after organ transplantation. Many factors contribute to the pathogenesis of transplant osteoporosis, such as bone disease preceding transplantation, immunosuppressive medications, and nutritional and lifestyle factors. This study aimed to assess the incidence of vertebral fractures before and after lung and heart transplantation. This longitudinal study analyzed 213 electronic medical records of patients who underwent lung transplantation (n = 128) and heart transplantation (n = 85) at Siena University Medical Center between January 2000 and December 2018. In lung and heart transplant recipients, the bone mineral density in the femoral sub-regions show a significant decrease at post-transplantation and at follow up visits. In both lung and heart recipients, we found an increase in the fracture incidence in the first period after transplantation (19.5% vs. 50.4% in lung recipients; 9.6% vs. 25.7% in heart recipients). Moreover, in lung recipients, vertebral fractures were predicted primarily by age, BMD at the femur, and any history of fracture. In heart recipients, vertebral fractures were predicted only by history of fracture. Our study supports the recommendations for pre-transplant osteoporosis screening in patients undergoing lung transplants, and in the first period after transplantation in heart transplant recipients.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
- Correspondence: ; Tel.: +39-0577-585468; Fax: +39-0577-233446
| | - Maria D. Tomai Pitinca
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
| | - Mario Alessandri
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - David Bennett
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Antonella Fossi
- Respiratory Diseases and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (P.C.); (E.B.); (D.B.); (A.F.)
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (M.D.T.P.); (M.A.); (S.G.)
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Thongprayoon C, Acharya P, Aeddula NR, Torres-Ortiz A, Bathini T, Sharma K, Ungprasert P, Watthanasuntorn K, Suarez MLG, Salim SA, Kaewput W, Chenbhanich J, Mao MA, Cheungpasitporn W. Effects of denosumab on bone metabolism and bone mineral density in kidney transplant patients: a systematic review and meta-analysis. Arch Osteoporos 2019; 14:35. [PMID: 30852679 DOI: 10.1007/s11657-019-0587-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The use of immunosuppressive agents, especially glucocorticoids, are associated with increased risks of bone loss in kidney transplant patients. Denosumab, a potent antiresorptive agent, has been shown to increase bone mineral density (BMD) in patients with CKD. However, its effects on bone metabolism and BMD in kidney transplant patients remain unclear. METHODS A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through April 2018 to identify studies evaluating denosumab's effect on changes in bone metabolism and BMD from baseline to post-treatment course in kidney transplant patients. Study results were pooled and analyzed utilizing random-effects model. The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095055). RESULTS Five studies (a clinical trial and four cohort studies) with a total of 162 kidney transplant patients were identified. The majority of patients had a baseline eGFR ≥ 30 mL/min/1.73 m2. After treatment (≥ 6 to 12 months), there were significant increases in BMD with standardized mean differences (SMDs) of 3.26 (95% CI 0.88-5.64) and 1.83 (95% CI 0.43 to 3.22) for lumbar spine and femoral neck, respectively. There were also significant increases in T scores with SMDs of 0.92 (95% CI 0.58 to 1.25) and 1.14 (95% CI 0.17 to 2.10) for lumbar spine and femoral neck, respectively. After treatment, there were no significant changes in serum calcium (Ca) or parathyroid hormone (PTH) from baseline to post-treatment course (≥ 6 months) with mean differences (MDs) of 0.52 (95% CI, - 0.13 to 1.16) mmol/L and - 13.24 (95% CI, - 43.85 to 17.37) ng/L, respectively. The clinical trial data demonstrated more asymptomatic hypocalcemia in the denosumab (12 episodes in 39 patients) than in the control (1 episode in 42 patients) group. From the cohort studies, the pooled incidence of hypocalcemia following denosumab treatment was 1.7% (95% CI 0.4 to 6.6%). All reported hypocalcemic episodes were mild and asymptomatic, but the majority of patients required Ca and vitamin D supplements. CONCLUSION Among kidney transplant patients with good allograft function, denosumab effectively increases BMD and T scores in the lumbar spine and femur neck. From baseline to post-treatment, there are no differences in serum Ca and PTH. However, mild hypocalcemia can occur following denosumab treatment, requiring monitoring and titration of Ca and vitamin D supplements.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prakrati Acharya
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216, USA
| | - Narothama Reddy Aeddula
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Deaconess Health System, Evansville, IN, USA
| | - Aldo Torres-Ortiz
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Maria Lourdes Gonzalez Suarez
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216, USA
| | - Sohail Abdul Salim
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jirat Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216, USA.
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Kratochvílová S, Brunová J, Wohl P, Lánská V, Saudek F. Retrospective Analysis of Bone Metabolism in Patients on Waiting List for Simultaneous Pancreas-Kidney Transplantation. J Diabetes Res 2019; 2019:5143021. [PMID: 31218231 PMCID: PMC6536959 DOI: 10.1155/2019/5143021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Posttransplant osteoporosis, which evolves from preexisting bone pathologies, represents a serious complication with deteriorating consequences. The aim of our study was to evaluate epidemiological data on bone mineral density (BMD) in subjects with type 1 diabetes (T1DM) in advanced stages of diabetic nephropathy indicated for simultaneous pancreas-kidney transplantation (SPK). We retrospectively compiled biochemical and densitometrical data from 177 patients with T1DM at CKD (chronic kidney disease) stages G4-G5 (115 men, 62 women, median age 40 yr, diabetes duration 23 yr) enrolled on waiting list for SPK for the first time between the years 2011 and 2016. Median Z-scores were as follows: lumbar spine (LS): -0.8 [interquartile range -1.75 to 0.1]; total hip (TH): -1.2 [-1.75 to -0.6]; femoral neck (FN): -1.2 [-1.9 to -0.7]; and distal radius (DR): -0.8 [-1.4 to -0.1]. We noted a gender difference in LS, with worse results for men (-1.1 vs. -0.3) even after adjusting for BMI (body mass index) and glomerular filtration (p < 0.001). Osteoporotic and osteopenic ranges (based on T-scores) for all major sites were 27.7% and 56.5%, respectively, with similar results across both genders. Women had a significantly higher proportion of normal BMD in LS than men (67.7 vs. 49.4%, p < 0.05). Patients with T1DM at CKD stages G4-G5 exhibited serious BMD impairment despite their young age. Men surprisingly displayed lower Z-scores and higher percentages of pathological BMD values in LS than women did. The introduction of adequate preventive measures during the advanced stages of diabetic nephropathy to prevent bone loss is recommended.
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Affiliation(s)
- Simona Kratochvílová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
| | - Jana Brunová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
| | - Petr Wohl
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
| | - Věra Lánská
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
| | - František Saudek
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
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Shrosbree JE, Elder GJ, Eisman JA, Center JR. Acute hypocalcaemia following denosumab in heart and lung transplant patients with osteoporosis. Intern Med J 2018; 48:681-687. [PMID: 29363863 DOI: 10.1111/imj.13744] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/21/2017] [Accepted: 01/17/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Osteoporosis is highly prevalent in the heart and lung transplant population. Given high rates of concurrent renal impairment, there is increasing use of denosumab in this population. However, denosumab may be associated with hypocalcaemia, particularly in patients with chronic kidney disease (CKD). AIM To explore the risk of hypocalcaemia in a heart and lung transplant cohort prescribed denosumab for osteoporosis. METHODS We performed a retrospective database review of all surviving heart and lung transplant patients who had received denosumab for osteoporosis between January 2012 and November 2015. We assessed the rates of hypocalcaemia in this cohort and collected baseline clinical data to determine associated factors. RESULTS Ten patients received denosumab and had laboratory results available within 3 months of the dose. Of these, three patients developed severe (grade 4) hypocalcaemia, while two patients developed mild (grade 1) hypocalcaemia. In comparison to the five patients who remained normocalcaemic, patients with hypocalcaemia had significantly lower baseline mean estimated glomerular filtration rate but similar baseline mean corrected serum calcium. Unexpectedly, patients developing hypocalcaemia had non-significantly higher levels of 25-hydroxyvitamin D and lower baseline doses of prednisone. CONCLUSIONS In heart and lung transplant patients, denosumab should be used judiciously in patients with advanced renal disease due to the risk of hypocalcaemia.
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Affiliation(s)
- Julia E Shrosbree
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, New South Wales, Australia
| | - Grahame J Elder
- Department of Endocrinology, St. Vincent's Hospital, Sydney, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, Australia
| | - John A Eisman
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, New South Wales, Australia.,Department of Endocrinology, St. Vincent's Hospital, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, New South Wales, Australia.,Department of Endocrinology, St. Vincent's Hospital, Sydney, Australia
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Brunova J, Kratochvilova S, Stepankova J. Osteoporosis Therapy With Denosumab in Organ Transplant Recipients. Front Endocrinol (Lausanne) 2018; 9:162. [PMID: 29720961 PMCID: PMC5915642 DOI: 10.3389/fendo.2018.00162] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Osteoporosis and fragility fractures represent serious complications for the solid organ transplant population. The recommended osteoporosis therapy for organ recipients involves supplementation with calcium and vitamin D and bisphosphonate administration. However, these options can prove limited for patients with impaired renal function. An alternative therapy option is offered by denosumab, a monoclonal antibody that targets receptor activator of nuclear factor kappa-B ligand. PATIENTS AND METHODS We evaluated 63 patients with osteoporosis (23 males and 40 females, age 56.4 ± 13.1 years) following solid organ transplantation (15 diabetic patients after simultaneous transplantation of the kidney and pancreas, 34 patients after kidney transplantation, and 14 patients with liver grafts). Osteoporosis was diagnosed according to standard DEXA examination using the Lunar Prodigy apparatus. Transplanted patients with impaired renal function were treated for osteoporosis of the lumbar spine (L-spine) and/or proximal femur with calcium and vitamin D supplementation and 60 mg of denosumab every 6 months between the years 2012 and 2017. The mean duration of the therapy was 1.65 ± 0.7 years. RESULTS After denosumab therapy, L-spine T-scores improved across the whole group, ranging from -2.7 ± 0.09 to -1.8 ± 1.0 (p < 0.001). T-score values for the proximal femur increased from -2.5 ± 0.8 to -2.0 ± 0.7 after the therapy (p < 0.01). We observed only a mild, statistically insignificant improvement in distal forearm T-scores. The mean increase in L-spine bone mineral density (BMD) was 11.5 ± 6.2% in subjects with osteoporosis at this site and 10.4 ± 6.1% in the case of all patients. BMD of the proximal femur increased by 10.4 ± 8.3% in patients with osteoporosis and by 7.5 ± 7.3% in all patients. Denosumab therapy decreased the prevalence of osteoporosis in the L-spine from 75 to 27% (p < 0.001) and proximal femur osteoporosis from 54 to 36% (p < 0.05). Denosumab therapy reduced elevated levels of osteocalcin and beta-crosslaps (βCTX) in comparison with baseline levels (p < 0.001) across the whole group of graft recipients. CONCLUSION Denosumab therapy was well-tolerated and improved bone density in our group of solid organ transplant recipients. The indications are that denosumab could be a viable therapeutic option for transplanted patients with osteoporosis, especially in those with renal function impairment or bisphosphonate intolerance.
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Palmisano AC, Kuhn AW, Urquhart AG, Pour AE. Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: a case series. INTERNATIONAL ORTHOPAEDICS 2016; 41:13-19. [DOI: 10.1007/s00264-016-3265-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/25/2016] [Indexed: 01/05/2023]
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Pirsl F, Curtis LM, Steinberg SM, Tella SH, Katić M, Dobbin M, Hsu J, Hakim FT, Mays JW, Im AP, Pulanić D, Mitchell SA, Baruffaldi J, Masuch L, Halverson DC, Gress RE, Barsony J, Pavletic SZ. Characterization and Risk Factor Analysis of Osteoporosis in a Large Cohort of Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2016; 22:1517-1524. [PMID: 27118572 DOI: 10.1016/j.bbmt.2016.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/16/2016] [Indexed: 01/23/2023]
Abstract
The National Institutes of Health Chronic Graft-versus-Host Disease (cGVHD) Consensus Project Ancillary and Supportive Care Guidelines recommend annual assessment of bone mineral density (BMD) to monitor bone health. The study of osteoporosis in patients with cGVHD has been limited to small numbers of patients, and the guidelines are based on experience with other chronic diseases and expert opinion. We hypothesized that the prevalence of osteoporosis is high in a cohort of 258 patients with moderate to severe cGVHD because of prolonged exposure to risk factors for osteoporosis after allogeneic hematopoietic stem cell transplantation. We defined osteoporosis using BMD criteria (T-score ≤-2.5) at 3 anatomic sites-the femoral neck (FN), lumbar spine (LS), and total hip (TH)-and characterized risk factors through univariate and multivariate analyses. We found that low body weight (FN, P < .0001; LS, P = .0002; TH, P < .0001), malnutrition (FN, P = .0002; LS, P = .03; TH, P = .0076), higher platelet count (FN, P = .0065; TH, P = .0025), higher average National Institutes of Health organ score (FN, P = .038), higher prednisone dose (LS, P = .032), lower complement component 3 (LS, P = .0073), and physical inactivity (FN, P = .01) were associated with osteoporosis in at least 1 site. T-scores were significantly lower in the FN compared with the LS or TH (P < .0001 for both). The prevalence of osteoporosis and osteopenia was high (17% and 60%, respectively), supporting current recommendations for frequent monitoring of BMD. The association of higher platelet count in patients with cGVHD and osteoporosis has not been reported previously and represents a new area of interest in the study of osteoporosis after allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Filip Pirsl
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lauren M Curtis
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Seth M Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sri Harsha Tella
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mašenjka Katić
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marnie Dobbin
- Clinical Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Hsu
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Fran T Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacqueline W Mays
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Annie P Im
- Adult Hematopoietic Stem Cell Transplant Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dražen Pulanić
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia; Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Judy Baruffaldi
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Licia Masuch
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David C Halverson
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ronald E Gress
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Julianna Barsony
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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