1
|
Kim KJ, Ha J, Kim SW, Kim JE, Lee S, Choi HS, Hong N, Kong SH, Ahn SH, Park SY, Baek KH. Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations. Endocrinol Metab (Seoul) 2024; 39:267-282. [PMID: 38693817 PMCID: PMC11066446 DOI: 10.3803/enm.2024.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 05/03/2024] Open
Abstract
This review article investigates solid organ transplantation-induced osteoporosis, a critical yet often overlooked issue, emphasizing its significance in post-transplant care. The initial sections provide a comprehensive understanding of the prevalence and multifactorial pathogenesis of transplantation osteoporosis, including factors such as deteriorating post-transplantation health, hormonal changes, and the impact of immunosuppressive medications. Furthermore, the review is dedicated to organ-specific considerations in transplantation osteoporosis, with separate analyses for kidney, liver, heart, and lung transplantations. Each section elucidates the unique challenges and management strategies pertinent to transplantation osteoporosis in relation to each organ type, highlighting the necessity of an organ-specific approach to fully understand the diverse manifestations and implications of transplantation osteoporosis. This review underscores the importance of this topic in transplant medicine, aiming to enhance awareness and knowledge among clinicians and researchers. By comprehensively examining transplantation osteoporosis, this study contributes to the development of improved management and care strategies, ultimately leading to improved patient outcomes in this vulnerable group. This detailed review serves as an essential resource for those involved in the complex multidisciplinary care of transplant recipients.
Collapse
Affiliation(s)
- Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Kim
- Department of Molecular Medicine, Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sihoon Lee
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Han Seok Choi
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Hee Ahn
- Department of Endocrinology and Metabolism, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - So Young Park
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki-Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - on Behalf of Metabolic Bone Disease Study Group of Korean Endocrine Society
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine, Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Endocrinology and Metabolism, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
2
|
Chen H, Lai YR, Yang Y, Gau SY, Huang CY, Tsai TH, Huang KH, Lee CY. High risk of osteoporosis and fracture following solid organ transplantation: a population-based study. Front Endocrinol (Lausanne) 2023; 14:1167574. [PMID: 37288297 PMCID: PMC10242127 DOI: 10.3389/fendo.2023.1167574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Osteoporosis and fractures increase morbidity and mortality rates after solid organ transplantation (SOT), but few studies have analyzed the risk of osteoporosis and related fractures after SOT. In this retrospective cohort study, we investigated the risk of osteoporosis and fractures in different SOT recipients. Methods This study was a retrospective cohort study using a nationally representative database in Taiwan. We collected the data of SOT recipients and used the propensity score matching method to obtain a comparison cohort. To reduce bias, we excluded patients who had been diagnosed with osteoporosis or fracture before inclusion. All participants were followed up until the date of diagnosis as having a pathological fracture, death, or the end of 2018, whichever occurred first. The Cox proportional hazards model was used to investigate the risk of osteoporosis and pathological fracture in SOT recipients. Results After adjustment for the aforementioned variables, SOT recipients were observed to have a higher risk of osteoporosis (hazard ratio (HR) = 1.46, 95% confidence interval (CI): 1.29-1.65) and fracture (HR: 1.19, 95% CI: 1.01-1.39) than the general individuals. Among the different SOT recipients, the highest risk of fractures was noted in heart or lung transplant recipients, with a HR of 4.62 (95% CI: 2.05-10.44). Among the age groups, patients aged >61 years had the highest HRs for osteoporosis (HR: 11.51; 95% CI, 9.10-14.56) and fracture (HR: 11.75, 95% CI: 8.97-15.40). Conclusion SOT recipients had a higher risk of osteoporosis and related fractures than the general population, with the highest risks observed in patients receiving heart or lung transplants, older patients, and patients with CCI scores of >3.
Collapse
Affiliation(s)
- Hsin Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Linkou Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yung-Rung Lai
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yih Yang
- Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Yang Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
3
|
Grassi G, Cairoli E, Gentile LMS, Chiodini I, Zampogna M, Ghielmetti A, Morlacchi LC, Rossetti V, Rosso L, Righi I, Nosotti M, Arosio M, Blasi F, Eller Vainicher C. Bone Disease in Long-Term Lung Transplant Survivors. Life (Basel) 2023; 13:life13040928. [PMID: 37109457 PMCID: PMC10146054 DOI: 10.3390/life13040928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Background: During the first two years after lung transplantation (LTx), the incidence of fragility fractures (FX) is estimated to be 15–50% and it is lower in patients with cystic fibrosis (CF) as compared with other end-stage lung diseases (nCF). The aim of our study is to compare the skeletal outcomes, after the first 2 years post-LTx, in long-term survivors with CF and nCF. Materials and Methods: We evaluated the FX rate, the changes in bone mineral density (BMD) and trabecular bone score (TBS) in 68 patients (38 CF and 30 nCF) who underwent LTx in our center and with a follow-up after LTx longer than 5 years (7.3 ± 2.0 years). Results: After the second year post-LTx: (i) the FX rate was lower than during the first two years post-LTx (4.4 vs. 20.6%, p = 0.004), with no difference between CF and nCF patients (5.3 vs. 3.3%, p = 0.589); (ii) BMD at lumbar spine, femoral neck and total hip remained stable (−1.6 ± 1.0 vs. −1.4 ± 1.1, p = 0.431, −1.8 ± 0.9 vs. −1.9 ± 0.9, p = 0.683, −1.5 ± 0.9 vs. −1.4 ± 0.9, p = 0.678, respectively) as well as TBS (1.200 ± 0.124 vs. 1.199 ± 0.205, p = 0.166). Conclusions: After the second year post-LTx, the skeletal complications become less frequent and have similar incidence in patients with CF and nCF.
Collapse
Affiliation(s)
- Giorgia Grassi
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Elisa Cairoli
- Unit for Bone Metabolism Diseases and Diabetes, Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, 20122 Milan, Italy
| | | | - Iacopo Chiodini
- Unit of Endocrinology, Ospedale Niguarda Cà Granda, 20162 Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20123 Milan, Italy
| | - Marta Zampogna
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Alberto Ghielmetti
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Letizia Corinna Morlacchi
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Rossetti
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lorenzo Rosso
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Nosotti
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maura Arosio
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy
| | - Francesco Blasi
- Respiratory Unit, Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20123 Milan, Italy
| | - Cristina Eller Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
4
|
Intertrochanteric fracture fixation in solid organ transplant patients: outcomes and survivorship. Arch Orthop Trauma Surg 2022; 142:2739-2745. [PMID: 34345938 DOI: 10.1007/s00402-021-04096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Solid organ transplantation (SOT) recipients have complex medical and surgical risk factors; however, the outcomes of these patients undergoing surgical fixation of hip fractures are unknown. This study sought to evaluate SOT patients' outcomes and survivorship after intertrochanteric (IT) fracture fixation. METHODS A retrospective review identified 12 SOT patients who underwent cephalomedullary (CMN) nail fixation for IT fractures and were matched (1:2) to a cohort of 24 non-SOT IT fracture patients. Perioperative results and complications, mortality/patient survivorship, and clinical outcomes were compared between the cohorts. RESULTS The time from presentation to surgical fixation was within 48 h of presentation for the non-SOT patients, while only 75% of SOT patients underwent surgery within 48 h of presentation (p = 0.034). The 90-day readmission rate for SOT patients was 25% versus 13% in the non-SOT group (p = 0.38). Similarly, the SOT cohort experienced a higher rate of major medical complication (25% vs. 13%, p = 0.38). There were two (16%) reoperations in the SOT group and three (13%) in the non-SOT matched group (p = 0.99). Respectively, the 90-day and 1-year estimated patient survivorship was similar between the two cohorts: SOT patients with 92% (95% CI 54-99%) and 73% (95% CI 24-93%) versus 86% (95% CI 62-95%) and 72% (95% CI 47-86%, HR 0.92, 95% CI 0.18-4.62, p = 0.92) in non-SOT patients. CONCLUSION SOT patients who underwent CMN fixation for IT fractures required more time from hospital presentation to surgical management than non-SOT patients. Although not statistically significant, SOT patients demonstrated more acute complications and readmissions, but similar mortality compared to those without transplant.
Collapse
|
5
|
Kuppachi S, Cheungpasitporn W, Li R, Caliskan Y, Schnitzler MA, McAdams-DeMarco M, Ahn JB, Bae S, Hess GP, Segev DL, Lentine KL, Axelrod DA. Kidney Transplantation, Immunosuppression, and Fracture Risk: Clinical and Economic Implications. Kidney Med 2022; 4:100474. [PMID: 35669410 PMCID: PMC9166366 DOI: 10.1016/j.xkme.2022.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rationale & Objective Disorders of bone and mineral metabolism frequently develop with advanced kidney disease, may be exacerbated by immunosuppression after kidney transplantation, and increase the risk of fractures. Study Design Retrospective database study. Setting & Participants Kidney-only transplant recipients aged ≥18 years from 2005 to 2016 in the United States captured in US Renal Data System records, which integrate Organ Procurement and Transplantation Network/United Network for Organ Sharing records with Medicare billing claims. Exposures Various immunosuppression regimens in the first 3 months after kidney transplantation. Outcomes The development of fractures, as ascertained using diagnostic codes on Medicare billing claims. Analytical Approach We used multivariable Cox regression with inverse propensity weighting to compare the incidence of fractures >3 months-to-3 years after kidney transplantation associated with various immunosuppression regimens compared to a reference regimen of antithymocyte globulin (TMG) or alemtuzumab (ALEM) with tacrolimus + mycophenolic acid + prednisone using inverse probability treatment weighting. Results Overall, fractures were identified in 7.5% of kidney transplant recipients (women, 8.8%; men, 6.7%; age < 55 years, 5.9%; age ≥ 55 years, 9.3%). In time-varying regression, experiencing a fracture was associated with a substantially increased risk of subsequent death within 3 months (adjusted hazard ratio [aHR], 3.06; 95% confidence interval [CI], 2.45-3.81). Fractures were also associated with increased Medicare spending (first year: $5,122; second year: $10,890; third year: $11,083; [P < 0.001]). Induction with TMG or ALEM and the avoidance or early withdrawal of steroids significantly reduced the risk of fractures in younger (aHR, 0.63; 95% CI, 0.54-0.73) and older (aHR, 0.83; 95% CI, 0.74-0.94) patients. The avoidance or early withdrawal of steroids with any induction was associated with a reduced risk of fractures in women. Limitations This was a retrospective study which lacked data on immunosuppression levels. Conclusions Fractures after kidney transplantation are associated with significantly increased mortality risk and costs. The early avoidance or early withdrawal of steroids after induction with TMG or ALEM reduces the risk of fractures after kidney transplantation and should be considered for patients at high-risk of this complication, including older adults and women.
Collapse
Affiliation(s)
- Sarat Kuppachi
- Organ Transplant Center, University of Iowa, Iowa City, IA
| | | | - Ruixin Li
- Saint Louis University Transplant Center, Saint Louis University, St. Louis, MO
| | - Yasar Caliskan
- Saint Louis University Transplant Center, Saint Louis University, St. Louis, MO
| | - Mark A. Schnitzler
- Saint Louis University Transplant Center, Saint Louis University, St. Louis, MO
| | | | - JiYoon B. Ahn
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Gregory P. Hess
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Krista L. Lentine
- Saint Louis University Transplant Center, Saint Louis University, St. Louis, MO
- Address for Correspondence: Krista L. Lentine, MD, PhD, Saint Louis University Transplant Center, 1201 S. Grand Blvd., St. Louis, MO 63104.
| | | |
Collapse
|
6
|
Ng E, Topliss DJ, Paraskeva M, Paul E, Sztal-Mazer S. The Utility of Prophylactic Zoledronic Acid in Patients Undergoing Lung Transplantation. J Clin Densitom 2021; 24:581-590. [PMID: 33189560 DOI: 10.1016/j.jocd.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022]
Abstract
Osteoporosis is prevalent among lung transplant candidates and is exacerbated post-transplant by immunosuppressive therapy. Low bone mineral density (BMD) is a well-recognized surrogate for fragility fracture risk, which is associated with significant morbidity and mortality. Intravenous zoledronic acid (ZA) effectively reduces BMD loss and prevents fractures in postmenopausal osteoporosis. Many groups, ours included, prophylactically treat lung transplant recipients (LTR) with bisphosphonates, but no documented consensus currently exists. Our protocol comprises ZA every 6-months from transplant wait-listing, with interval reassessment to guide ongoing treatment. We evaluate the impact of a dose of ZA within 6 months of transplantation on BMD and fracture occurrence. A retrospective analysis was performed on all adult LTR from April 2012 to October 2014, of which 60 met our inclusion criteria. LTR who received ZA within 6 months of transplantation (n = 37) were compared to those who did not (n = 23), and followed up for a minimum of three years. Outcome measures were BMD change at the lumbar spine and femur (primary), and fracture occurrence (secondary). LTR treated with ZA within 6 months of transplantation experienced a median BMD change of +8.11% at the lumbar spine and +1.39% at the femur, compared to -1.20% and -3.92%, respectively, in LTR who did not receive a ZA dose within 6 months of transplantation (p = 0.002 & p = 0.008 respectively). Our findings indicate that prophylactic ZA within 6 months of transplantation prevents BMD loss in LTR.
Collapse
Affiliation(s)
- Elisabeth Ng
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia.
| | - Duncan J Topliss
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Miranda Paraskeva
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Respiratory Medicine, Alfred Health, Victoria, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Shoshana Sztal-Mazer
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| |
Collapse
|
7
|
Impact of bone-active drugs and underlying disease on bone health after lung transplantation: A longitudinal study. J Cyst Fibros 2021; 20:e100-e107. [PMID: 34366281 DOI: 10.1016/j.jcf.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/15/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION the effect of bone-active drugs on the risk of fragility fractures (Fx), bone mineral density (BMD) and trabecular bone score (TBS) changes in patients receiving lung transplantation (LTx) is largely unknown. This study assessed the bone-active drugs effect in patients undergoing LTx both with (CF) and without (nCF) cystic-fibrosis. METHODS We evaluated incident Fx, both clinical and morphometric vertebral Fx by spinal X-ray, BMD and trabecular bone score (TBS) in 117 patients (CF=50, nCF n = 67) before and 24-months after LTx. A bone-active therapy was proposed to all LTx candidates. RESULTS 83.8% of patients started a bone-active drug. Lumbar-spine (LS) T-score improved significantly only in treated patients (-1.4 ± 1.0 vs -2.0±1.0, p = 0.0001), whereas femur BMD and TBS remained stable in treated and not treated subjects. The rate of incident Fx was 15.3%, with no difference between treated and not treated patients. After LTx, LS T-score improved significantly only in nCF group (-1.3 ± 1.0 vs -1.8 ± 1.1, p = 0.0001), while femur remained stable in both nCF and CF groups. Patients with CF showed a significant Z-TBS increase (-3.6 ± 1.7 vs -3.0 ± 1.7, p = 0.019) and a lower Fx incidence as compared with nCF patients (4.1% vs 24.2%, p =0.003). Incident Fx were associated with nCF diagnosis (OR 7.300, CI95% 1.385-38.461, p = 0.019) regardless of prevalent Fx, previous glucocorticoid therapy and bone-active therapy introduced at least 6 months before LTx. CONCLUSIONS A prompt medical intervention helps in preventing BMD loss after LTx. As compared with nCF patients, CF patients show a TBS increase and a lower Fx risk after LTx.
Collapse
|
8
|
Burtscher D, Dalla Torre D. Dental implant procedures in immunosuppressed organ transplant patients: a systematic review. Int J Oral Maxillofac Surg 2021; 51:380-387. [PMID: 34274207 DOI: 10.1016/j.ijom.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.
Collapse
Affiliation(s)
- D Burtscher
- University Clinic of Prosthodontics, Medical University Innsbruck, Innsbruck, Austria.
| | | |
Collapse
|
9
|
Haseltine KN, Chukir T, Smith PJ, Jacob JT, Bilezikian JP, Farooki A. Bone Mineral Density: Clinical Relevance and Quantitative Assessment. J Nucl Med 2020; 62:446-454. [PMID: 33310738 DOI: 10.2967/jnumed.120.256180] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility-fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the fracture risk assessment tool (FRAX) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the U.S. National Osteoporosis Foundation guidelines, postmenopausal women and men at least 50 y old with osteopenic BMD warrant pharmacologic treatment if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. Although reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiple-fracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy with an improvement in BMD, or who have an incident fragility fracture on therapy, secondary causes of osteoporosis or non-compliance with medical therapy should be considered.
Collapse
Affiliation(s)
- Katherine N Haseltine
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tariq Chukir
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pinar J Smith
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin T Jacob
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - John P Bilezikian
- Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Azeez Farooki
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
10
|
Abate EG, Vega MV, Rivas AM, Meek S, Yang L, Ball CT, Kearns AE. Evaluation of Factors Associated With Fracture and Loss of Bone Mineral Density Within 1 Year After Liver Transplantation. Endocr Pract 2020; 27:426-432. [PMID: 33645516 DOI: 10.1016/j.eprac.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Orthotopic liver transplant recipients are at high risk of fragility fractures both in pre-liver transplant (pre-LT) and in the immediate posttransplant (post-LT) period. The aims of this study were to identify risk factors associated with post-LT fracture and identify factors that contribute to changes in bone mineral density (BMD) in post-LT as they relate to the risk of fracture in the immediate post-LT period. METHODS We conducted a retrospective cohort study of first-time LT recipients who had BMD testing within 2-year pre-LT and 1-year post-LT. We assessed factors associated with immediate post-LT fracture using logistic regression models and linear regression models. RESULTS New fractures occurred in 41/286 (14.3%) of LT recipients during the first year following LT. In multivariate analysis, we noted an increased odds of fracture for patients with prior history of fracture (P < .001), patients who were older (P = .03), patients with higher end-stage liver disease score (P = .03), and patients with lower BMD. After adjustment for multiple testing, only a history of prior fracture was statistically significant. CONCLUSION Our study demonstrated that prior fracture at any site was associated with developing a new fracture in the first year post-LT.
Collapse
Affiliation(s)
| | - Myrian Vinan Vega
- Division of Endocrinology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Ana M Rivas
- Division of Endocrinology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Shon Meek
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
| | - Liu Yang
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
11
|
Bhagra S, Parameshwar J. Outcomes following cardiac transplantation in adults. Indian J Thorac Cardiovasc Surg 2020; 36:166-174. [DOI: 10.1007/s12055-019-00796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
|
12
|
Ala M, Jafari RM, Dehpour AR. Diabetes Mellitus and Osteoporosis Correlation: Challenges and Hopes. Curr Diabetes Rev 2020; 16:984-1001. [PMID: 32208120 DOI: 10.2174/1573399816666200324152517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 01/14/2023]
Abstract
Diabetes and osteoporosis are two common diseases with different complications. Despite different therapeutic strategies, managing these diseases and reducing their burden have not been satisfactory, especially when they appear one after the other. In this review, we aimed to clarify the similarity, common etiology and possible common adjunctive therapies of these two major diseases and designate the known molecular pattern observed in them. Based on different experimental findings, we want to illuminate that interestingly similar pathways lead to diabetes and osteoporosis. Meanwhile, there are a few drugs involved in the treatment of both diseases, which most of the time act in the same line but sometimes with opposing results. Considering the correlation between diabetes and osteoporosis, more efficient management of both diseases, in conditions of concomitant incidence or cause and effect condition, is required.
Collapse
Affiliation(s)
- Moein Ala
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
| | - Razieh Mohammad Jafari
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
| |
Collapse
|
13
|
Siddiqui MB, Patel S, Bhati C, Reichman T, Williams K, Driscoll C, Liptrap E, Rinella ME, Sterling RK, Siddiqui MS. Range of Normal Serum Aminotransferase Levels in Liver Transplant Recipients. Transplant Proc 2019; 51:1895-1901. [PMID: 31399173 DOI: 10.1016/j.transproceed.2019.04.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
Abstract
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are used to monitor liver transplant recipients (LTR) but the reference range and context of its use is not well defined. We aimed to determine the healthy ranges in LTR without chronic liver disease. METHODS One hundred and three LTR without chronic liver disease based on serology, transient elastography with controlled attenuated parameter, and ultrasound were included. A healthy range of aminotransferases was set to 95th percentile. An updated normal aminotransferase range was used to detect recurrence in post-liver transplantation (LT) with hepatitis C virus (HCV) and nonalcoholic fatty liver disease (NAFLD). RESULTS The normal ALT and AST range was 0 to 57 and 0 to 54 IU/L, respectively, in LTR and was not affected by age, sex, obesity, or choice of immunosuppressant. The diagnostic performance of serum ALT and AST to detect recurrence of NAFLD by a controlled attenuated parameter was poor with area under the receiver operating characteristic curve of 0.573 (95% confidence interval 0.493, 0.655; P = .08) and 0.537 (0.456, 0.618; P = .4), respectively. In contrast, the diagnostic performance of ALT and AST to detect recurrence of HCV after LT was 0.906 (0.868, 0.944; P < .001) and 0.925 (0.890, 0.959; P < .001), respectively. CONCLUSION The updated aminotransferase range in LTR is higher than the general population and accurate for detecting recurrent HCV, but not NAFLD.
Collapse
Affiliation(s)
- Mohammad Bilal Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia.
| | - Samarth Patel
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - Chandra Bhati
- Division of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Trevor Reichman
- Division of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kenyada Williams
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - Carolyn Driscoll
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - Erika Liptrap
- Division of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Mary E Rinella
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Richard K Sterling
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| | - M Shadab Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
14
|
Anastasilakis AD, Tsourdi E, Makras P, Polyzos SA, Meier C, McCloskey EV, Pepe J, Zillikens MC. Bone disease following solid organ transplantation: A narrative review and recommendations for management from The European Calcified Tissue Society. Bone 2019; 127:401-418. [PMID: 31299385 DOI: 10.1016/j.bone.2019.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Solid organ transplantation is an established therapy for end-stage organ failure. Both pre-transplantation bone disease and immunosuppressive regimens result in rapid bone loss and increased fracture rates. METHODS The European Calcified Tissue Society (ECTS) formed a working group to perform a systematic review of existing literature on the consequences of end-stage kidney, liver, heart, and lung disease on bone health. Moreover, we assessed the characteristics of post-transplant bone disease and the skeletal effects of immunosuppressive agents and aimed to provide recommendations for the prevention and treatment of transplantation-related osteoporosis. RESULTS Characteristics of bone disease may differ depending on the organ that fails, but patients awaiting solid organ transplantation frequently depict a wide spectrum of bone and mineral abnormalities. Common features are a decreased bone mass and impaired bone strength with consequent high fracture risk, all of which are aggravated in the early post-transplantation period. CONCLUSION Both the underlying disease leading to end-stage organ failure and the immunosuppression regimens implemented after successful organ transplantation have detrimental effects on bone mass, quality and strength. Given existing ample data confirming the high frequency of bone disease in patients awaiting solid organ transplantation, we recommend that all transplant candidates should be assessed for osteoporosis and fracture risk and, if indicated, treated before and after transplantation. Since bone loss in the early post-transplantation period occurs in virtually all solid organ recipients and is associated with glucocorticoid administration, the goal should be to use the lowest possible dose and to taper and withdraw glucocorticoids as early as possible.
Collapse
Affiliation(s)
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Force & VA General Hospital, Athens, Greece
| | - Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christian Meier
- Division of Endocrinology, Diabetology and Metabolism, University Hospital and University of Basel, Switzerland
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
| |
Collapse
|
15
|
Osseointegration of Dental Implants in Organ Transplant Patients Undergoing Chronic Immunosuppressive Therapy. IMPLANT DENT 2019; 28:447-454. [DOI: 10.1097/id.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Sidhaye A, Goldswieg B, Kaminski B, Blackman SM, Kelly A. Endocrine complications after solid-organ transplant in cystic fibrosis. J Cyst Fibros 2019; 18 Suppl 2:S111-S119. [DOI: 10.1016/j.jcf.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 01/07/2023]
|
17
|
Ni LH, Tang RN, Yuan C, Song KY, Wang LT, Wang XC, Zhang YX, Zhang XL, Zhu DD, Liu BC. FK506 prevented bone loss in streptozotocin-induced diabetic rats via enhancing osteogenesis and inhibiting adipogenesis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:265. [PMID: 31355232 DOI: 10.21037/atm.2019.05.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Type 1 diabetes mellitus (DM) is associated with severe osteoporosis, which is still a great challenge in the clinic. This work aimed to investigate the skeletal effects of FK506 in a rat model of streptozocin induced type 1 DM. Methods Rats were divided into three groups: control (CTL), DM rats and DM rats treated with FK506. Dual energy X-ray absorption, micro-computed tomography, bone mechanics and bone histology were used for skeletal analysis. Bone marrow adipocytes infiltrations were detected by oil red O stain and H&E stain. In addition, the protein expression of adipocyte-specific makers (PPAR-γ, C/EBP-αβ), osteoblast-specific markers (Runx2, Osterix) and nuclear translocation of β-catenin in femurs were determined by western blot. Results In the study, bone mineral density of femurs and lumbar vertebras in diabetic rats were increased after FK506 administration. FK506 treatment resulted in higher cancellous bone volume but had no significant effect on cortical bones in diabetic rats. The ultimate force and work to failure were increased in DM+FK506 group, while they were reduced in the DM group. Compared with the CTL, the infiltration of bone marrow adipocytes was significantly increased in the DM group, which was reduced after the treatment of FK506. Besides, the expression levels of Runx2 and Osterix were up-regulated, and that of PPAR-γ and C/EBP-α were down-regulated in diabetic rats after FK506 treatment. In addition, the nuclear translocation of β-catenin protein levels were increased in diabetic rats after the treatment of FK506. Conclusions Our study indicated that FK506 could alleviate bone loss in diabetic rats. This effects could be due to the results of enhancing osteogenesis and inhibiting adipogenesis, which might be regulated by activation the nuclear translocation of β-catenin.
Collapse
Affiliation(s)
- Li-Hua Ni
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Ri-Ning Tang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China.,Department of Nephrology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Nanjing 10009, China
| | - Cheng Yuan
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Kai-Yun Song
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Li-Ting Wang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Xiao-Chen Wang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Yu-Xia Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Xiao-Liang Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| | - Dong-Dong Zhu
- Department of Nephrology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing 210009, China
| |
Collapse
|
18
|
Buxbaum NP, Robinson C, Sinaii N, Ling A, Curtis LM, Pavletic SZ, Baird K, Lodish MB. Impaired Bone Mineral Density in Pediatric Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 24:1415-1423. [PMID: 29496562 PMCID: PMC6045967 DOI: 10.1016/j.bbmt.2018.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/15/2018] [Indexed: 11/18/2022]
Abstract
Pediatric allogeneic hematopoietic stem cell transplantation (AHSCT) recipients with chronic graft-versus-host disease (cGVHD) are at high risk for endocrinopathies, particularly impaired bone mineral density (BMD). However, rates of BMD impairment in pediatric AHSCT recipients with cGVHD have not been well documented. We report 33 patients with cGVHD who were referred to the National Institutes of Health (NIH) for the Natural History of Clinical and Biological Factors Determining Outcomes in Chronic Graft-versus-Host Disease Study (NCT 0092235) and underwent formal BMD assessment via dual-energy X-ray absorptiometry (DEXA). Not surprisingly, we found much higher rates of BMD impairment than previously reported for pediatric AHSCT recipients who were not stratified by the presence or absence of cGVHD. Most of these patients (73%) had a z-score ≤-2 in at least 1 anatomic site. Although we expected the rate to be higher than that observed for pediatric AHSCT recipients in studies that did not analyze patients with cGVHD separately, this rate is nonetheless extremely high. Furthermore, the overall rate of occult vertebral compression fractures (VCFs) in our cohort was 17%, and the rate was 23% in patients with at least 1 z-score of ≤-2. The rates of BMD impairment and VCF in our pediatric cohort were significantly higher than those seen in the adult AHSCT recipients who were concurrently enrolled on the same study at the NIH and had similar cGVHD severity. We found that older age at cGVHD diagnosis and a greater number of systemic therapies were associated with occult VCF. Moreover, the intensity of current immunosuppression negatively impacted lumbar spine and total hip BMD in this cohort. Our study, although limited by small patient numbers and lack of a control AHSCT recipient group without cGVHD, indicates that children with cGVHD are at a greater risk for BMD impairment than previously appreciated. Given the rising incidence of cGVHD in AHSCT recipients and our findings, we recommend that pre-AHSCT DEXA be incorporated into routine pediatric pretransplantation screening studies. A baseline DEXA study could facilitate longitudinal monitoring of BMD in children, who may be more susceptible than adults to the negative effects of AHSCT on BMD. In addition, given the high risk of BMD impairment in pediatric AHSCT recipients with cGVHD, such patients should undergo BMD evaluation upon developing cGVHD, with continued monitoring thereafter to allow intervention before progression of the BMD impairment to its severe manifestation, VCF.
Collapse
Affiliation(s)
- Nataliya P Buxbaum
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland.
| | - Cemre Robinson
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Alexander Ling
- Diagnostic Radiology Department, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Lauren M Curtis
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Kristin Baird
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland; Division of Clinical Evaluation, Pharmacology and Toxicology, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Maya B Lodish
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
19
|
Putman MS, Simoneau T, Feldman HA, Haagensen A, Boyer D. Low bone density and fractures before and after pediatric lung transplantation. Bone 2018; 111:129-134. [PMID: 29596964 PMCID: PMC5931383 DOI: 10.1016/j.bone.2018.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/26/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Children undergoing lung transplant are at risk for low bone mineral density (BMD) and fractures. The effect of lung transplantation on bone health in pediatric patients is unknown. MATERIALS AND METHODS We performed a retrospective chart review of all patients ages 2-21 years who underwent lung transplantation at our hospital from January 2000 to January 2015. RESULTS 51 patients were studied. At the time of transplant evaluation, BMD Z-score was -2.2 ± 1.4, and 59% of patients had low BMD. BMD Z-score declined in the first year after treatment and returned to near-baseline by the third post-transplant year. Fractures occurred in 9 patients (18%) before and 15 patients (29%) after transplant. Bisphosphonate use was associated with improvement in BMD Z-score and lower mortality risk. CONCLUSIONS Pediatric patients had a high prevalence of low BMD at the time of lung transplant evaluation. BMD Z-scores declined in the year after transplant and returned to the pre-transplant level by the third post-transplant year while remaining below normal levels. Fractures were common at sites associated with significant morbidity. These findings support efforts to optimize bone health before and after pediatric lung transplantation, and future studies are needed to evaluate the role of bisphosphonates in these patients.
Collapse
Affiliation(s)
- Melissa S Putman
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States; Endocrine Unit, Massachusetts General Hospital, Boston, MA, United States.
| | - Tregony Simoneau
- Department of Pulmonary Medicine, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Henry A Feldman
- Clinical Research Center, Boston Children's Hospital, Boston, MA, United States
| | - Alexandra Haagensen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
| | - Debra Boyer
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
20
|
Herborn J, Parulkar S. Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery. Anesthesiol Clin 2017; 35:539-553. [PMID: 28784225 DOI: 10.1016/j.anclin.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant, and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. This article reviews the posttransplant physiology and anesthetic considerations for patients after solid organ transplantation.
Collapse
Affiliation(s)
- Joshua Herborn
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Suraj Parulkar
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL 60611, USA
| |
Collapse
|
21
|
Coskun Y, Paydas S, Balal M, Soyupak S, Kara E. Bone Disease and Serum Fibroblast Growth Factor-23 Levels in Renal Transplant Recipients. Transplant Proc 2017; 48:2040-5. [PMID: 27569941 DOI: 10.1016/j.transproceed.2016.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/19/2016] [Accepted: 05/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Posttransplantation bone disease develops commonly and results in important complications. In this study, we aimed to investigate the relationship between bone diseases and serum fibroblast growth factor-23 (FGF-23) in renal transplant recipients. METHODS This study was conducted in 106 kidney transplant recipients (KTrs; group G1) and 30 patients with chronic kidney disease (group G2). Patients with fever, heart failure, angina pectoris, acute renal failure, malignant disease, or any gastrointestinal disease were excluded. KTrs were treated with triple immunosuppressive drugs including glucocorticoids. Complete blood count (CBC), blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR, Modification of Diet in Renal Disease [MDRD] formula), lipid profile, calcium (Ca), phosphorous (P), parathormone (PTH), 25OHD3, serum levels of tacrolimus/cyclosporine, and intact FGF-23 were measured. Bone mineral density (BMD) was measured with dual energy X-ray absorptiometry. RESULTS The mean patient age was 40.1 ± 11.1 years and 39.2 ± 11.3 years in G1 and G2, respectively (P > .05). In G1 and G2, 76 and 15 patients were male, respectively. Compared with the G2 patients, G1 patients had lower body mass index (BMI), serum glucose levels, P, Mg, and Ca·P (P < .05 for all). T scores of the lumbar vertebrae/femur were -1.82 ± 0.99/-1.34 ± 0.89 and -1.13 ± 1.34/-0.51 ± 1.18 in G1 and G2 patients, respectively (P < .05 for all). The incidences of osteopenia/osteoporosis in the lumbar spine and femur were 50.9%/27.4% and 57.5%/10.4% in G1 and 16.6%/23.3%, and 40%/3.3% in G2. There were positive correlations between BMD and BMI, the time elapsed after renal transplantation, and GFR. In our study, a statistically significant relationship was found between lipid parameters and BMD, PTH, and 250HD3 levels, as well as use of corticosteroid and calcineurin inhibitors (P < .05 for all). In G1 and G2, BMD of the lumbar spine in patients with serum creatinine >1.5 mg/dL was lower than that in patients with serum creatinine <1.5 mg/dL. CONCLUSION The association between age and BMD was found only in the femur of KTrs. No relationship was observed between serum FGF-23 levels and BMD values. In both groups, the BMD T score of the lumbar spine was lower compared to the BMD T score of the femur and in patients with serum creatinine >1.5 mg/dL. In long-term follow-up of renal transplantation by as much as 58 months, the incidence of bone disease such as osteoporosis/osteopenia was as high as 67% and was also higher than that of nontransplant patients with similar GFR. In addition to decreased renal function, dyslipidemia, inflammation, and continuing hypophosphatemia were also accompanied by decreased BMD as in cardiovascular disease in KTrs.
Collapse
Affiliation(s)
- Y Coskun
- Department of Internal Medicine and Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - S Paydas
- Department of Internal Medicine and Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - M Balal
- Department of Internal Medicine and Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - S Soyupak
- Department of Radiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - E Kara
- Department of Public Health, Cukurova University Faculty of Medicine, Adana, Turkey
| |
Collapse
|
22
|
CYP3A4 is a crosslink between vitamin D and calcineurin inhibitors in solid organ transplant recipients: implications for bone health. THE PHARMACOGENOMICS JOURNAL 2017; 17:481-487. [PMID: 28418012 DOI: 10.1038/tpj.2017.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 01/18/2017] [Indexed: 11/08/2022]
Abstract
The use of calcineurin inhibitors (CNIs) and vitamin D deficiency may contribute to the pathogenesis of post-transplant bone disease. CNIs and 1,25-dihydroxyvitamin D₃ (1,25(OH)2D3) are substrates of the drug-metabolizing enzyme CYP3A4. This review summarizes the indications for the use of activated vitamin D analogs in post-transplant care and the current knowledge on the impact of CNIs on bone. We searched for clinical evidence of the interaction between CNIs and 1,25(OH)2D3. We also provide an overview of the literature on the interplay between vitamin D metabolism and CYP3A4 in experimental and clinical settings and discuss its possible implications for solid organ transplant recipients. In conclusion, there is a body of evidence on the interplay between vitamin D and the drug-metabolizing enzyme CYP3A4, which may have therapeutic implications.
Collapse
|
23
|
Jain RK, Bennet B, Vokes T. Ethnic Differences in Osteoporosis After Cardiac Transplantation. J Clin Densitom 2017; 20:164-171. [PMID: 27595486 DOI: 10.1016/j.jocd.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/10/2016] [Indexed: 01/30/2023]
Abstract
Cardiac transplantation is associated with a high risk of fracture. African Americans (AAs) are believed to have a lower risk of osteoporosis than Caucasians, but it is not clear whether they are also protected from osteoporosis resulting from the use of glucocorticoids and/or organ transplantation. We examined possible ethnic differences in 33 cardiac transplant recipients (16 AAs) in a cross-sectional analysis. In addition to bone mineral density and vertebral fracture assessment, we also compared biochemical variables, trabecular bone score, total body dual-energy X-ray absorptiometry, and disability. Overall fracture rates were low in both groups, with only 6 total subjects with fractures on vertebral fracture assessment or history of fracture. While T-scores were similar between groups, Z-scores were lower in AA with the difference reaching statistical significance when controlling for important covariates. The trabecular bone score was also lower in AAs than in Caucasians even when adjusting for age and tissue thickness (1.198 ± 0.140 vs 1.312 ± 0.140, p = 0.03). While AAs are generally thought to be protected from osteoporosis, our study instead suggests that AAs may be at higher risk of bone deterioration after cardiac transplantation and may need to be managed more aggressively than suggested by current guidelines.
Collapse
Affiliation(s)
- Rajesh K Jain
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL, USA.
| | - Betsy Bennet
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL, USA
| | - Tamara Vokes
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL, USA
| |
Collapse
|
24
|
Reid AT, Perdue A, Goulet JA, Robbins CB, Pour AE. Complicated Outcomes After Emergent Lower Extremity Surgery in Patients With Solid Organ Transplants. Orthopedics 2016; 39:e1063-e1069. [PMID: 27459137 DOI: 10.3928/01477447-20160719-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023]
Abstract
The complications of emergent or urgent surgery in solid organ transplant recipients are unclear. The goal of this nonrandomized retrospective case study, conducted at a large public university teaching hospital, was to determine the following: (1) 90-day postsurgical complications in solid organ transplant recipients who undergo fracture surgery of the lower extremities; (2) 90-day and 1-year mortality rates for this cohort; (3) correlation of particular postsurgical complications with the 90-day or 1-year mortality rate; and (4) correlation of body mass index with the 90-day or 1-year mortality rate. Subjects included 36 solid organ transplant recipients who underwent surgical treatment for 37 emergent or urgent lower extremity fractures within 72 hours of presentation to the emergency department. Patients were followed for all medical and surgical complications for 90 days and for all-cause mortality for 1 year. Within 90 days of surgery, patients had complications that included acute renal failure (15, 40.5%), deep venous thrombosis (3, 8.1%), pulmonary embolus (2, 5.4%), pneumonia (7, 18.9%), superficial surgical site infection (3, 8.1%), and nonorthopedic sepsis (4, 10.8%). In addition, 3 (8.1%) and 5 (13.9%) patients died within 90 days and 1 year, respectively. Hospital readmission correlated with a higher 1-year mortality rate (odds ratio, 14.000; P=.016). Higher body mass index correlated with higher 90-day (odds ratio, 1.425; P=.035) and 1-year (odds ratio, 1.334; P=.033) mortality rates. Solid organ transplant recipients with lower extremity fracture have high 90-day and 1-year mortality rates and may have multiple complications within 90 days of treatment. [Orthopedics. 2016; 39(6):e1063-e1069.].
Collapse
|
25
|
Guobis Z, Pacauskiene I, Astramskaite I. General Diseases Influence on Peri-Implantitis Development: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2016; 7:e5. [PMID: 27833730 PMCID: PMC5100645 DOI: 10.5037/jomr.2016.7305] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To systematically review the influence of systemic diseases or medications used in their treatment on the dental implant therapy success. MATERIAL AND METHODS The search strategy was implemented on the National Library of Medicine database (MEDLINE) (Ovid) and EMBASE electronic databases between January 2006 and January 2016. Human studies with available English articles analysing the relationship between dental implant therapy success and systemic diseases, such as diabetes mellitus, AIDS/HIV, rheumatoid arthritis, osteoporosis, Crohn's disease, cardiovascular diseases, scleroderma, Sjögren's syndrome, lichen planus, ectodermal dysplasia, post-transplantation status, were included in present review according to the PRISMA guidelines. The review protocol was registered on PROSPERO system with the code CRD42016033662. RESULTS Present review included forty one retrospective and prospective follow-up studies, case-control studies, case report series and cohort studies. Despite some limitations this study reveals positive results of implantation in most systemic conditions that should be interpreted with caution. Influence of cardiovascular diseases on the dental implantation success should be explored deeply, because of controversial results and likelihood of comorbidity expressed by a history of cardiovascular diseases and periodontitis. There is only a weak relationship with bone density in osteoporosis and implant failure. All the other diseases did not show significant effect on implantation success. CONCLUSIONS Recent studies with low strength of evidence and controversy show that systemic diseases may have potential effect on the success of implantation, but further detailed studies are needed to provide these findings.
Collapse
Affiliation(s)
- Zygimantas Guobis
- Department of Oral and Dental Pathology, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Ingrida Pacauskiene
- Department of Oral and Dental Pathology, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Inesa Astramskaite
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| |
Collapse
|
26
|
Prytuła A, Walle JV, Van Vlierberghe H, Kaufman JM, Fiers T, Dehoorne J, Raes A. Factors associated with 1,25-dihydroxyvitamin D3 concentrations in liver transplant recipients: a prospective observational longitudinal study. Endocrine 2016; 52:93-102. [PMID: 26433738 DOI: 10.1007/s12020-015-0757-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023]
Abstract
The aim of the study was to identify factors associated with 1,25(OH)2D3 concentrations in liver transplant recipients with emphasis on the renal function and catabolism. We also tested the hypothesis that tacrolimus increases 1,25(OH)2D3 concentrations. Serum 25(OH)D3, 1,25(OH)2D3, and 24,25(OH)2D3 were measured in 41 patients before, at 2 weeks and 3 months after transplantation. Dose-adjusted tacrolimus concentration was used as a surrogate marker of CYP3A4 activity. Factors associated with 1,25(OH)2D3 were identified using multivariate linear regression analysis. The median 1,25(OH)2D3 levels remained stable: 55 versus 46 pg/ml (P = 0.36) despite an increase in 25(OH)D3 from 18 ng/ml at baseline to 26 ng/ml (P = 0.03), serum albumin (34 to 41 g/l, P = 0.02), and comparable eGFR at baseline and month 3 (94 and 92 ml/min, respectively, P = 0.15). At 3 months 19 % of patients had 1,25(OH)2D3 < 25 pg/ml. Low eGFR and a low dose-adjusted tacrolimus concentration were both independently associated with 1,25(OH)2D3 at 3 months. Liver transplant recipients with impaired renal function or a low dose-adjusted tacrolimus concentration suggesting a high CYP3A4 are at risk of low 1,25(OH)2D3 concentrations. The use of tacrolimus does not lead to an increase in 1,25(OH)2D3 concentrations in a clinical setting.
Collapse
Affiliation(s)
- Agnieszka Prytuła
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Vande Walle
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Jo Dehoorne
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Ann Raes
- Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW Mineral and bone disorders are common problems in organ transplant recipients. Successful transplantation solves many aspects of abnormal mineral and bone metabolism, but the degree of improvement is frequently incomplete. Posttransplant bone disease can affect long-term outcomes as well as increase the likelihood of fracture. In this article, we reviewed the major posttransplant bone diseases and recent advances in treatment strategies. RECENT FINDINGS Pretransplant bone disease and immunosuppressants are important risk factors for posttransplant bone disease. Corticosteroid withdrawal may result in minimal or no protection against fractures, with increased risk for acute rejection. Vitamin D analogue and bisphosphonate are frequently used to prevent and treat posttransplant osteoporosis. Posttransplant hyperparathyroidism increases the risk for all-cause mortality and graft loss, but not major cardiovascular events. Cinacalcet was well tolerated and effectively controlled hypercalcemic hyperparathyroidism; however, it did not improve bone mineral density and discontinuation led to parathyroid hormone rebound. Six-month paricalcitol supplementation reduced parathyroid hormone levels and attenuated bone remodeling and mineral loss in case of posttransplant hyperparathyroidism. SUMMARY Posttransplant bone diseases present in various forms, including osteoporosis, hyperparathyroidism, adynamic bone disease, and osteonecrosis. Prophylactic and therapeutic approaches to both pretransplant and posttransplant periods should be considered.
Collapse
Affiliation(s)
- Hee Jung Jeon
- aDepartment of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea bDivision of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea cTransplantation Center, Seoul National University Hospital, Seoul, Republic of Korea *Hee Jung Jeon and Hyosang Kim contributed equally to the writing of this article
| | | | | |
Collapse
|
28
|
Current Status of Research on Osteoporosis after Solid Organ Transplantation: Pathogenesis and Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:413169. [PMID: 26649301 PMCID: PMC4662986 DOI: 10.1155/2015/413169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 12/23/2022]
Abstract
Improved survival following organ transplantation has brought to the forefront some long-term complications, among which osteoporosis and associated fractures are the major ones that adversely affect the quality of life in recipients. The pathogenesis of osteoporosis in transplant recipients is complex and multifactorial which may be related to increased bone resorption, decreased bone formation, or both. Studies have shown that the preexisting underlying metabolic bone disorders and the use of immunosuppressive agents are the major risk factors for osteoporosis and fractures after organ transplantation. And rapid bone loss usually occurs in the first 6–12 months with a significant increase in fracture risk. This paper will provide an updated review on the possible pathogenesis of posttransplant osteoporosis and fractures, the natural history, and the current prevention and treatment strategies concerning different types of organ transplantation.
Collapse
|
29
|
Versele EB, Van Laecke S, Dhondt AW, Verbeke F, Vanholder R, Van Biesen W, Nagler EV. Bisphosphonates for preventing bone disease in kidney transplant recipients: a meta-analysis of randomized controlled trials. Transpl Int 2015; 29:153-64. [PMID: 26369899 DOI: 10.1111/tri.12691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/21/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
Abstract
An estimated 60% of kidney transplant recipients have mineral bone disease and about 0.5% break their hip within the first year after transplantation. We conducted a systematic review of benefits and harms of bisphosphonates in kidney transplant recipients. We searched CENTRAL (Issue 5, 2015) for randomized controlled trials in all languages and screened the reference list of an earlier Cochrane review. One reviewer identified the trials, extracted all data, and assessed risk of bias. Meta-analysis used a random effects model, with results expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Bisphosphonates have uncertain effects on death (RR 0.45, CI 0.04-4.69) and vertebral fractures (RR 0.58, CI 0.24-1.43, I(2) 0%). Bisphosphonates moderately to importantly reduce the loss of vertebral bone mineral density (MD 5.98%, CI 3.77-8.18% change from baseline in g calcium/cm² at 12 months, I(2) 91%) and femoral bone mineral density (MD 5.57%, 3.12-8.01% change from baseline in g calcium/cm² at 12 months, I(2) 69%). At this stage, insufficient evidence exists to support routine use of bisphosphonates to reduce fracture risk after kidney transplantation. Data on important health outcomes are lacking, surrogate outcomes poorly reflect bone quality in kidney transplant recipients, and serious adverse events are not studied and reported systematically.
Collapse
Affiliation(s)
- Emmanuelle B Versele
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Steven Van Laecke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Annemieke W Dhondt
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Francis Verbeke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.,European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.,European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium
| | - Evi V Nagler
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.,European Renal Best Practice (ERBP), guidance body of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), Ghent, Belgium
| |
Collapse
|
30
|
Büyükkaragöz B, Bakkaloglu SA, Kandur Y, Isiyel E, Akcaboy M, Buyan N, Hasanoglu E. The evaluation of bone metabolism in children with renal transplantation. Pediatr Transplant 2015; 19:351-7. [PMID: 25819470 DOI: 10.1111/petr.12469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 01/16/2023]
Abstract
This study aims to evaluate BMD and bone biomarkers and to investigate the effects of immunosuppressives on bone disease after RTx. Thirty-three RTR aged 16.7 ± 3.7 yr and healthy controls (n = 32) were enrolled. There was no difference between pre-RTx BMD and BMD at the time of study (45.9 ± 30.9 months after RTx), while both values were lower than controls (p < 0.01 and p < 0.05, respectively). Worst BMD scores were obtained at sixth month after RTx (-0.2 ± 0.9) and best at fourth year (1.4 ± 1.3). 25-hydroxy-(OH) vitamin D and OPG were higher in RTR (p < 0.001). BMD z scores negatively correlated with OPG and cumulative CS doses at the time of study (r = -0.344, p < 0.05 and r = -0.371, p < 0.05, respectively). Regression analysis revealed OPG as the only predictor of BMD (β -0.78, 95% CI -0.004 to -0.013, p < 0.001). The increase in OPG, a significant predictor of BMD, could either be secondary to graft dysfunction or for protection against bone loss. CS doses should be minimized to avoid their untoward effects on bone metabolism.
Collapse
|
31
|
Etxebarria-Foronda I, Arrospide A, Soto-Gordoa M, Caeiro JR, Abecia LC, Mar J. Regional variability in changes in the incidence of hip fracture in the Spanish population (2000-2012). Osteoporos Int 2015; 26:1491-7. [PMID: 25572051 DOI: 10.1007/s00198-014-3015-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED The objective is to analyse the evolution of the incidence of hip fracture in the female population of Spain from 2000 to 2012 and to establish the possible changes which may have been seen over this period of time, including the trends in the different regions of the country. INTRODUCTION Fragility-related hip fractures are considered to be the fractures of greatest significance to public health due to their high degree of morbidity and mortality. The change in their incidence, both in absolute values and when adjusted for age, is the subject of debate. The objective of this article is to describe the changes in the rates of hip fracture in Spain by autonomous community between the years 2000 and 2012. METHODS Using the data from the Spanish Minimum Basic Data Set, in which are all the recorded cases of women with a principal diagnosis of hip fracture, the incidence rates by age group and by autonomous community were obtained. Poisson distribution or negative binomial regressions were carried out to estimate the average annual change over the time period analysed. RESULTS There have been statistically significant changes in the trends of rates of incidence for all age groups of women over 65 years of age. The annual reduction was 2.2% for women of 65-74 years of age and less for those between 75 and 84. The rates of incidence for those over 85 increased annually by 0.58%. CONCLUSIONS Hip fractures continue to increase in absolute numbers, although if the rates are adjusted for age, a downward trend is seen in certain age groups. These findings have various origins, although in the absence of great changes in population structure, we believe that drug treatments for osteoporosis may play a role. There is variability in the change in incidence of hip fractures in different parts of the country. Further studies are required to be able to identify the causes.
Collapse
|
32
|
Tewari P, Franklin AR, Tarek N, Askins MA, Mofield S, Kebriaei P. Hematopoietic stem cell transplantation in adolescents and young adults. Acta Haematol 2014; 132:313-25. [PMID: 25228557 DOI: 10.1159/000360211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) are a very unique subset of our population journeying through a dynamic stage of their lives. This age group often remains understudied as a separate entity because they are commonly lumped into either pediatric or adult subgroups. METHODS Here we review acute and chronic issues surrounding hematopoietic stem cell transplantation (HSCT) with a focus on the AYA age group. RESULTS HSCT is a commonly used treatment modality for patients with certain types of cancers. AYA patients undergoing HSCT present a very unique perspective, circumstances, medical, psychological and social issues requiring a diligent workup, care and follow-up. CONCLUSION The medical care of these patients should be approached in a multidisciplinary method involving the patient, caregivers, physicians, psychologists and social workers.
Collapse
|
33
|
Yu TM, Lin CL, Chang SN, Sung FC, Huang ST, Kao CH. Osteoporosis and fractures after solid organ transplantation: a nationwide population-based cohort study. Mayo Clin Proc 2014; 89:888-95. [PMID: 24809760 DOI: 10.1016/j.mayocp.2014.02.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the incidence of bone disorders after solid organ transplantation (SOT). PARTICIPANTS AND METHODS We used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex- and age- matched control subjects between January 1, 1997, and December 31, 2010, to compare the incidence and risk of bone disorders between groups. RESULTS Recipients of SOT had a significantly higher incidence of osteoporosis and related fractures compared with the non-SOT group. The overall hazard ratio (HR) of osteoporosis after SOT was 5.14 (95% CI, 3.13-8.43), and the HR of related fractures was 5.76 (95% CI, 3.80-8.74). The highest HRs were observed in male patients (HR, 7.09; 95% CI, 3.09-16.3) and in those aged 50 years or younger (HR, 7.38; 95% CI, 2.46-22.1). In addition, SOT patients without any comorbidities had a 9.03-fold higher risk of osteoporosis than non-SOT participants (HR, 9.03; 95% CI, 5.29-15.4). To compare the risk of osteoporosis and related fractures in different recipients of SOT, the highest risk of osteoporosis and fractures was noted in patients receiving lung transplantation, followed by other types of SOT. CONCLUSION We report high rates of metabolic bone disorders after SOT in chronic transplant patients over a long follow-up. Both underlying bone disorders before transplantation and use of immunosuppressant agents may contribute to bone disorders after transplantation.
Collapse
Affiliation(s)
- Tung-Min Yu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ting Huang
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
34
|
Kulak CAM, Borba VZC, Kulak Júnior J, Custódio MR. Bone disease after transplantation: osteoporosis and fractures risk. ACTA ACUST UNITED AC 2014; 58:484-92. [DOI: 10.1590/0004-2730000003343] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/28/2014] [Indexed: 01/16/2023]
Abstract
Organ transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures.
Collapse
|
35
|
Naessén S, Bergström I, Ljungman P, Landgren BM. Long-term follow-up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies. Eur J Haematol 2014; 93:137-42. [DOI: 10.1111/ejh.12317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sabine Naessén
- Department of Woman and Child Health; Division of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
| | - Ingrid Bergström
- Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Per Ljungman
- Division of Hematology; Department of Medicine Huddinge; Department of Hematology; Karolinska University Hospital; Karolinska Institutet; Stockholm Sweden
| | - Britt-Marie Landgren
- Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| |
Collapse
|
36
|
Montebugnoli L, Venturi M, Cervellati F, Servidio D, Vocale C, Pagan F, Landini MP, Magnani G, Sambri V. Peri-Implant Response and Microflora in Organ Transplant Patients 1 Year after Prosthetic Loading: A Prospective Controlled Study. Clin Implant Dent Relat Res 2014; 17:972-82. [DOI: 10.1111/cid.12207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lucio Montebugnoli
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Mattia Venturi
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Fabio Cervellati
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Dora Servidio
- Section of Oral Science; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Caterina Vocale
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Flavia Pagan
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Maria Paola Landini
- Unit of Microbiology; Regional Reference Centre for Microbiological Emergencies; St. Orsola Malpighi University Hospital; Bologna Italy
| | - Gaia Magnani
- Cardiovascular Department; University of Bologna; Bologna Italy
| | - Vittorio Sambri
- Unit of Clinical Microbiology; The Hub Laboratory of the Greater Romagna Area; Pievesestina Cesena Italy
| |
Collapse
|
37
|
McCurry M, McDermott A, Crouchen N. Lung transplantation assessment in a patient with COPD: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:1250-4. [PMID: 24280927 DOI: 10.12968/bjon.2013.22.21.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article focuses on the lung transplant assessment process for a patient with chronic obstructive pulmonary disease (COPD). It explains the investigations undertaken and their relevance in the context of transplantation. For a patient to be accepted onto the lung transplant waiting list, it is important to establish that their lung disease is severe enough to warrant transplantation, while ensuring that the patient is well enough to undergo the procedure with the potential for a good subsequent quality of life. The article also explores the importance of supportive care, symptom management and psychosocial assessment in potential lung transplant recipients.
Collapse
Affiliation(s)
- Mandy McCurry
- Clinical Nurse Specialist in Transplantation, Harefield Hospital, Middlesex
| | | | | |
Collapse
|
38
|
Dasarathy S. Posttransplant sarcopenia: an underrecognized early consequence of liver transplantation. Dig Dis Sci 2013; 58:3103-11. [PMID: 23912247 PMCID: PMC4066193 DOI: 10.1007/s10620-013-2791-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Liver transplantation is believed to reverse the clinical and metabolic abnormalities of cirrhosis. Reduced skeletal muscle mass or sarcopenia contributes to increased mortality and adverse consequences of cirrhosis. Failure of reversal of sarcopenia of cirrhosis after liver transplantation is not well recognized. Six temporally, geographically, and methodologically distinct follow-up studies in 304 cirrhotics reported conflicting data on changes in indirect measures of skeletal muscle mass after transplantation. Distinct measures of body composition but not skeletal muscle mass were used and did not focus on the clinical consequences of sarcopenia after transplantation. A number of studies reported an initial rapid postoperative loss of lean mass followed by incomplete recovery with a maximum follow-up of 2 years. Posttransplant sarcopenia may be responsible for metabolic syndrome and impaired quality of life after liver transplantation. Potential reasons for failure to reverse sarcopenia after liver transplantation include use of immunosuppressive agents [mammalian target of rapamycin (mTOR) and calcineurin inhibitors] that impair skeletal muscle growth and protein accretion. Repeated hospitalizations, posttransplant infections, and renal failure also contribute to posttransplant sarcopenia. Finally, recovery from muscle deconditioning is limited by lack of systematic nutritional and physical-activity-based interventions to improve muscle mass. Despite the compelling data on sarcopenia before liver transplantation, the impact of posttransplant sarcopenia on clinical outcomes is not known. There is a compelling need for studies to examine the mechanisms and consequences of sarcopenia post liver transplantation to permit development of therapies to prevent and reverse this disorder.
Collapse
Affiliation(s)
- Srinivasan Dasarathy
- Department of Gastroenterology, Hepatology and Pathobiology, Cleveland Clinic, Lerner Research Institute, NE4 208, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
| |
Collapse
|
39
|
Pacifici R. Osteoimmunology and its implications for transplantation. Am J Transplant 2013; 13:2245-54. [PMID: 23915249 DOI: 10.1111/ajt.12380] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/08/2013] [Accepted: 05/14/2013] [Indexed: 01/25/2023]
Abstract
Osteoimmunology is a field of research dedicated to the study of the interactions between the immune system, the hemopoietic system and bone. Among the cells of the immune system that regulate bone cells and the hemopoietic function are T lymphocytes. These cells secrete inflammatory cytokines that promote bone resorption, as well as Wnt ligands that stimulate bone formation. In addition, T cells regulate bone homeostasis by cross talking with BM stromal cells and osteoblastic cells via CD40 ligand (CD40L) and other costimulatory molecules. This article describes the immune cells relevant to bone and the hemopoietic function, reviews the role of lymphocytes as mediators of the effects of PTH and estrogen in bone and the hemopoietic system and discusses the implication of osteoimmunology for transplant medicine.
Collapse
Affiliation(s)
- R Pacifici
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA; Immunology and Molecular Pathogenesis Program, Emory University, Atlanta, GA
| |
Collapse
|
40
|
Sofía Oviedo G. Osteoporosis secundaria. tratamiento actualizado. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
41
|
McDonald L, Luke J, Jude V, Chan K, Cuellar N. Development of an evidence-based clinical guideline for age-appropriate screening, prevention, and management of bone abnormalities in children post-hematopoietic stem cell transplant. J Pediatr Oncol Nurs 2013; 30:78-89. [PMID: 23380528 DOI: 10.1177/1043454212473653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Musculoskeletal complaints, pain, and weakness are common among children post-hematopoietic stem cell transplant (HSCT). Bone abnormalities include decreased bone mineral density and avascular necrosis, both affecting ambulation and quality of life for survivors. Several risk factors for both disorders among adults have been described along with suggested interventions. However, similar recommendations for screening and management of bone abnormalities among children and adolescents post-HSCT are not clearly defined. A review of the literature using PubMed, CINAHL, National Guideline Clearinghouse, and Cochrane Collection databases identified a paucity of reports specific to the management of bone abnormalities in children and adolescents post-HSCT. Although guidelines for evaluation of bone health in pediatric patients with cancer exist, none specifically address early screening and prevention. The purpose of this article is to provide a review of the literature on current evidence for age appropriate screening, prevention, and management of bone abnormalities in children post-HSCT and to present a clinical guideline for bone abnormalities in children post-HSCT used in a hospital-based outpatient center.
Collapse
Affiliation(s)
- Lisa McDonald
- Texas Transplant Physician Group, San Antonio, TX, USA.
| | | | | | | | | |
Collapse
|
42
|
Shane E, Cohen A, Stein EM, McMahon DJ, Zhang C, Young P, Pandit K, Staron RB, Verna EC, Brown R, Restaino S, Mancini D. Zoledronic acid versus alendronate for the prevention of bone loss after heart or liver transplantation. J Clin Endocrinol Metab 2012; 97:4481-90. [PMID: 23024190 PMCID: PMC3591679 DOI: 10.1210/jc.2012-2804] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The first year after transplantation is characterized by rapid bone loss. OBJECTIVE The aim of this study was to compare zoledronic acid (zoledronate) and alendronate for prevention of transplantation bone loss. DESIGN AND SETTING A randomized clinical trial was conducted at a transplantation center. PATIENTS The study included 84 adults undergoing heart or liver transplantation and a concurrently transplanted, nonrandomized reference group of 27 adults with T scores greater than -1.5. INTERVENTIONS Alendronate (70 mg weekly for 12 months) or one 5-mg infusion of zoledronate were both initiated 26 ± 8 d after transplantation. MAIN OUTCOME MEASURES The primary outcome was total hip bone mineral density (BMD) 1 yr after transplantation. Secondary outcomes included femoral neck and lumbar spine BMD and serum C-telopeptide, a bone resorption marker. RESULTS In the reference group, BMD declined at the spine and hip (P < 0.001). In the randomized groups, hip BMD remained stable. Spine BMD increased in the zoledronate group and did not change in the alendronate group; at 12 months, the 2.2% difference between groups (95% confidence interval, 0.6 to 3.9%; P = 0.009) favored zoledronate. In heart transplant patients, spine BMD declined in the alendronate and increased in the zoledronate group (-3.0 vs. +1.6%, respectively; between-group difference, 4.2%; 95% confidence interval, 2.1 to 6.3%; P < 0.001). In liver transplant patients, spine BMD increased comparably in both groups. Twelve-month C-telopeptide was lower in the zoledronate group than in the alendronate group (79 vs. 49%; P = 0.04). CONCLUSIONS One 5-mg infusion of zoledronate and weekly alendronate prevent bone loss at the hip and, in liver transplant patients, increase spine BMD. In heart transplant patients, spine bone BMD remained stable with zoledronate but decreased with alendronate.
Collapse
Affiliation(s)
- Elizabeth Shane
- Department of Medicine, Columbia University Medical Center, Columbia University, New York, New York 10032, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Alshayeb HM, Josephson MA, Sprague SM. CKD-mineral and bone disorder management in kidney transplant recipients. Am J Kidney Dis 2012; 61:310-25. [PMID: 23102732 DOI: 10.1053/j.ajkd.2012.07.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/09/2012] [Indexed: 12/11/2022]
Abstract
Kidney transplantation, the most effective treatment for the metabolic abnormalities of chronic kidney disease (CKD), only partially corrects CKD-mineral and bone disorders. Posttransplantation bone disease, one of the major complications of kidney transplantation, is characterized by accelerated loss of bone mineral density and increased risk of fractures and osteonecrosis. The pathogenesis of posttransplantation bone disease is multifactorial and includes the persistent manifestations of pretransplantation CKD-mineral and bone disorder, peritransplantation changes in the fibroblast growth factor 23-parathyroid hormone-vitamin D axis, metabolic perturbations such as persistent hypophosphatemia and hypercalcemia, and the effects of immunosuppressive therapies. Posttransplantation fractures occur more commonly at peripheral than central sites. Although there is significant loss of bone density after transplantation, the evidence linking posttransplantation bone loss and subsequent fracture risk is circumstantial. Presently, there are no prospective clinical trials that define the optimal therapy for posttransplantation bone disease. Combined pharmacologic therapy that targets multiple components of the disordered pathways has been used. Although bisphosphonate or calcitriol therapy can preserve bone mineral density after transplantation, there is no evidence that these agents decrease fracture risk. Moreover, bisphosphonates pose potential risks for adynamic bone disease.
Collapse
Affiliation(s)
- Hala M Alshayeb
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, USA
| | | | | |
Collapse
|
44
|
Chauhan V, Ranganna KM, Chauhan N, Vaid M, Kelepouris E. Bone disease in organ transplant patients: pathogenesis and management. Postgrad Med 2012; 124:80-90. [PMID: 22691902 DOI: 10.3810/pgm.2012.05.2551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bone disease is common in recipients of kidney, heart, lung, liver, and bone marrow transplants, and causes debilitating complications, such as osteoporosis, osteonecrosis, bone pain, and fractures. The frequency of fractures ranges from 6% to 45% for kidney transplant recipients to 22% to 42% for heart, lung, and liver transplant recipients. Bone disease in transplant patients is the sum of complex mechanisms that involve both preexisting bone disease before transplant and post-transplant bone loss due to the effects of immunosuppressive medications. Evaluation of bone disease should preferably start before the transplant or in the early post-transplant period and include assessment of bone mineral density and other metabolic factors that influence bone health. This requires close coordination between the primary care physician and transplant team. Patients should be stratified based on their fracture risk. Prevention and treatment include risk factor reduction, antiresorptive medications, such as bisphosphonates and calcitonin, calcitriol, and/or gonadal hormone replacement. A steroid-avoidance protocol may be considered.
Collapse
Affiliation(s)
- Veeraish Chauhan
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA.
| | | | | | | | | |
Collapse
|
45
|
Byun YK, Kim KH, Kim SH, Kim YS, Koo KT, Kim TI, Seol YJ, Ku Y, Rhyu IC, Lee YM. Effects of immunosuppressants, FK506 and cyclosporin A, on the osteogenic differentiation of rat mesenchymal stem cells. J Periodontal Implant Sci 2012; 42:73-80. [PMID: 22803008 PMCID: PMC3394998 DOI: 10.5051/jpis.2012.42.3.73] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 04/24/2012] [Indexed: 11/08/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effects of the immunosuppressants FK506 and cyclosporin A (CsA) on the osteogenic differentiation of rat mesenchymal stem cells (MSCs). Methods The effect of FK506 and CsA on rat MSCs was assessed in vitro. The MTT assay was used to determine the deleterious effect of immunosuppressants on stem cell proliferation at 1, 3, and 7 days. Alkaline phosphatase (ALP) activity was analyzed on days 3, 7, and 14. Alizarin red S staining was done on day 21 to check mineralization nodule formation. Real-time polymerase chain reaction (RT-PCR) was also performed to detect the expressions of bone tissue-specific genes on days 1 and 7. Results Cell proliferation was promoted more in the FK506 groups than the control or CsA groups on days 3 and 7. The FK506 groups showed increased ALP activity compared to the other groups during the experimental period. The ALP activity of the CsA groups did not differ from the control group in any of the assessments. Mineralization nodule formation was most prominent in the FK506 groups at 21 days. RT-PCR results of the FK506 groups showed that several bone-related genes-osteopontin, osteonectin, and type I collagen (Col-I)-were expressed more than the control in the beginning, but the intensity of expression decreased over time. Runx2 and Dlx5 gene expression were up-regulated on day 7. The effects of 50 nM CsA on osteonectin and Col-I were similar to those of the FK506 groups, but in the 500 nM CsA group, most of the genes were less expressed compared to the control. Conclusions These results suggest that FK506 enhances the osteoblastic differentiation of rat MSCs. Therefore, FK506 might have a beneficial effect on bone regeneration when immunosuppressants are needed in xenogenic or allogenic stem cell transplantation to treat bone defects.
Collapse
Affiliation(s)
- Yu-Kyung Byun
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Transplantation is an established therapy for end-stage diseases of kidney, lung, liver, and heart among others. Osteoporosis and fragility fractures are serious complications of organ transplantation, particularly in the first post-transplant year. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. This review addresses the mechanisms of bone loss that occurs both in the early and late post-transplant periods, including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac, and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient are also discussed.
Collapse
Affiliation(s)
- Carolina A Moreira Kulak
- Division of Endocrinology & Metabolism of Hospital de Clínicas-SEMPR, Federal University of Parana, Av. Agostinho Leão Júnior 285, Alto da Glória, Curitiba, Paraná, Cep: 80030-013, Brazil.
| | | | | | | |
Collapse
|
47
|
Affiliation(s)
- Yenna Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Soo Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Stein EM, Ortiz D, Jin Z, McMahon DJ, Shane E. Prevention of fractures after solid organ transplantation: a meta-analysis. J Clin Endocrinol Metab 2011; 96:3457-65. [PMID: 21849532 PMCID: PMC3205901 DOI: 10.1210/jc.2011-1448] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Bone loss and fracture are serious sequelae of organ transplantation, particularly in the first posttransplant year. Most interventional studies have been inadequately powered to detect effects on fracture. OBJECTIVE The objective of the study was to determine whether treatment with bisphosphonates (BP) or active vitamin D analogs (vitD) during the first year after transplantation reduces fracture risk and estimate the effect of these interventions on bone loss. DATA SOURCES Sources included PUBMED, MEDLINE, Cochrane Library, and abstracts from scientific meetings (presented 2003-2010). STUDY SELECTION Randomized controlled clinical trials of BP or vitD in solid organ transplant recipients were included if treatment was initiated at the time of transplantation and fracture data were collected. DATA EXTRACTION Two investigators independently extracted data and rated study quality. Fixed effect and random-effects models were used to obtain pooled estimates. DATA SYNTHESIS Eleven studies of 780 transplant recipients (134 fractures) were included. Treatment with BP or vitD reduced the number of subjects with fracture [odds ratio (OR) 0.50 (0.29, 0.83)] and number of vertebral fractures, [OR 0.24 (0.07, 0.78)]. An increase in bone mineral density at the lumbar spine [2.98% (1.31, 4.64)] and femoral neck [3.05% (2.16, 3.93)] was found with treatment. When BP trials (nine studies, 625 subjects) were examined separately, there was a reduction in number of subjects with fractures [OR 0.53 (0.30, 0.91)] but no significant reduction in vertebral fractures [OR 0.34 (0.09, 1.24)]. CONCLUSIONS Treatment with BP or vitD during the first year after solid organ transplant was associated with a reduction in the number of subjects with fractures and fewer vertebral fractures.
Collapse
Affiliation(s)
- Emily M Stein
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
| | | | | | | | | |
Collapse
|
49
|
Baccaro LF, Boin IFSF, Pedro AO, Costa-Paiva L, Leal ALG, Ramos CD, Pinto-Neto AM. Decrease in bone mass in women after liver transplantation: associated factors. Transplant Proc 2011; 43:1351-6. [PMID: 21620127 DOI: 10.1016/j.transproceed.2011.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the future, an increasing number of female liver transplant recipients will reach the climacteric with osteoporosis as a common complication. We evaluated the factors associated with decreased bone mass among women after liver transplantation. METHODS A prospective, cross-sectional study of 23 outpatient transplant recipients followed from February 2009 to March 2010 included women of age ≥35 years after liver transplantations ≥1 year prior. We recorded patient histories, liver enzyme levels, as well as bone mineral densities measured at the lumbar spine and femur. Statistical analysis used Fisher's exact test, simple odds ratio (OR), and Spearman's rank correlation coefficient. RESULTS The mean patient age was 52.5 ± 11 years with 30.4% premenopausal, and 69.6% perimenopausal or postmenopausal. Approximately 21% showed osteoporosis and 35%, a low bone mass. Postmenopausal women: OR 69.0 (95% CI 2.89-1647.18; P<.0001), aged ≥49 years: OR 13.33 (95% CI 1.78-100.15; P=.0123) and receiving a transplant after 44 years of age: OR 49.50 (95% CI 3.84-638.43; P<.0001) were associated with a lower bone mass. Having undergone transplantation for more than 5.8 years lowered the risk of bone mass change: OR 0.11 (95% CI 0.02-0.78; P=.0361). Clinical and laboratory variables, including corticosteroid use, were not associated with decreased bone mass. CONCLUSION Understanding the prevalence and factors associated with osteoporosis among female liver transplant recipients is important to enhance the strategies to diagnose and treat these women, seeking to improve their quality of life.
Collapse
Affiliation(s)
- L F Baccaro
- Department of Gynecology, State University of Campinas, Campinas, Brazil.
| | | | | | | | | | | | | |
Collapse
|
50
|
Oustecky DH, Riera AR, Rothstein KD. Long-term management of the liver transplant recipient: pearls for the practicing gastroenterologist. Gastroenterol Clin North Am 2011; 40:659-81. [PMID: 21893279 DOI: 10.1016/j.gtc.2011.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Liver transplantation is becoming more common and patients are surviving longer after transplantation. Special care must be paid to the long-term management of these patients because they are at increased risk for medical problems, malignancies, and adverse effects from immunosuppression. A stable and continuing relationship must be developed between the physician and the patient to optimize the long-term outcomes for these individuals.
Collapse
Affiliation(s)
- David H Oustecky
- Drexel University College of Medicine, Department of Gastroenterology and Hepatology, Mail Stop 913, 219 N. Broad Street, 5th Floor, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|