Osteoporosis following organ transplantation: Pathogenesis, diagnosis and management

Research output: Contribution to journalArticle

Abstract

Organ transplantation has become popular for the management of various chronic illnesses. With the advent of modern immunosuppressive treatments, the longevity of transplant recipients has increased. Consequently, morbid complications such as osteoporosis and bone fractures are seen at an increasing frequency in this population. In most transplant recipients, bone mineral density (BMD) falls shortly after transplantation. However, bone fracture rate plateaus in all except for post-renal transplant patients. Although the underlying pathophysiologic mechanism for this difference is not fully understood, potential mechanisms for sustained bone loss in renal transplant recipients may be persistent phosphorus wasting and defective bone mineralization. Current treatment regimens are based on studies in a small numbers of subjects with BMD as the primary outcome. Although BMD is recognized as a gold standard in the assessment of bone fracture risk, to date, its association with bone fracture risk in the general post-transplant population is not robust. Therefore, randomized controlled trials with bone fracture as the primary end point are crucial. The development of noninvasive bone markers in distinguishing bone turnover and bone mineralization status is also pivotal since skeletal lesions are heterogeneous in various organ transplantations. The elucidation of these underlying skeletal lesions is necessary for the consideration of selective treatment in this population.

Original languageEnglish (US)
Pages (from-to)157-176
Number of pages20
JournalExpert Review of Endocrinology and Metabolism
Volume6
Issue number2
DOIs
StatePublished - Mar 2011

Fingerprint

Bone Fractures
Organ Transplantation
Osteoporosis
Bone Density
Physiologic Calcification
Population
Transplants
Kidney
Bone and Bones
Bone Remodeling
Bone Development
Immunosuppressive Agents
Phosphorus
Chronic Disease
Therapeutics
Randomized Controlled Trials
Transplantation
Transplant Recipients

Keywords

  • bone disease
  • diagnosis
  • epidemiology
  • evaluation
  • natural history
  • pathogenesis
  • prevention
  • solid organ transplantation
  • treatment

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

@article{0ab015af63d54da6ad195e67b1ef3413,
title = "Osteoporosis following organ transplantation: Pathogenesis, diagnosis and management",
abstract = "Organ transplantation has become popular for the management of various chronic illnesses. With the advent of modern immunosuppressive treatments, the longevity of transplant recipients has increased. Consequently, morbid complications such as osteoporosis and bone fractures are seen at an increasing frequency in this population. In most transplant recipients, bone mineral density (BMD) falls shortly after transplantation. However, bone fracture rate plateaus in all except for post-renal transplant patients. Although the underlying pathophysiologic mechanism for this difference is not fully understood, potential mechanisms for sustained bone loss in renal transplant recipients may be persistent phosphorus wasting and defective bone mineralization. Current treatment regimens are based on studies in a small numbers of subjects with BMD as the primary outcome. Although BMD is recognized as a gold standard in the assessment of bone fracture risk, to date, its association with bone fracture risk in the general post-transplant population is not robust. Therefore, randomized controlled trials with bone fracture as the primary end point are crucial. The development of noninvasive bone markers in distinguishing bone turnover and bone mineralization status is also pivotal since skeletal lesions are heterogeneous in various organ transplantations. The elucidation of these underlying skeletal lesions is necessary for the consideration of selective treatment in this population.",
keywords = "bone disease, diagnosis, epidemiology, evaluation, natural history, pathogenesis, prevention, solid organ transplantation, treatment",
author = "Khashayar Sakhaee",
year = "2011",
month = "3",
doi = "10.1586/eem.10.86",
language = "English (US)",
volume = "6",
pages = "157--176",
journal = "Expert Review of Endocrinology and Metabolism",
issn = "1744-6651",
publisher = "Expert Reviews Ltd.",
number = "2",

}

TY - JOUR

T1 - Osteoporosis following organ transplantation

T2 - Pathogenesis, diagnosis and management

AU - Sakhaee, Khashayar

PY - 2011/3

Y1 - 2011/3

N2 - Organ transplantation has become popular for the management of various chronic illnesses. With the advent of modern immunosuppressive treatments, the longevity of transplant recipients has increased. Consequently, morbid complications such as osteoporosis and bone fractures are seen at an increasing frequency in this population. In most transplant recipients, bone mineral density (BMD) falls shortly after transplantation. However, bone fracture rate plateaus in all except for post-renal transplant patients. Although the underlying pathophysiologic mechanism for this difference is not fully understood, potential mechanisms for sustained bone loss in renal transplant recipients may be persistent phosphorus wasting and defective bone mineralization. Current treatment regimens are based on studies in a small numbers of subjects with BMD as the primary outcome. Although BMD is recognized as a gold standard in the assessment of bone fracture risk, to date, its association with bone fracture risk in the general post-transplant population is not robust. Therefore, randomized controlled trials with bone fracture as the primary end point are crucial. The development of noninvasive bone markers in distinguishing bone turnover and bone mineralization status is also pivotal since skeletal lesions are heterogeneous in various organ transplantations. The elucidation of these underlying skeletal lesions is necessary for the consideration of selective treatment in this population.

AB - Organ transplantation has become popular for the management of various chronic illnesses. With the advent of modern immunosuppressive treatments, the longevity of transplant recipients has increased. Consequently, morbid complications such as osteoporosis and bone fractures are seen at an increasing frequency in this population. In most transplant recipients, bone mineral density (BMD) falls shortly after transplantation. However, bone fracture rate plateaus in all except for post-renal transplant patients. Although the underlying pathophysiologic mechanism for this difference is not fully understood, potential mechanisms for sustained bone loss in renal transplant recipients may be persistent phosphorus wasting and defective bone mineralization. Current treatment regimens are based on studies in a small numbers of subjects with BMD as the primary outcome. Although BMD is recognized as a gold standard in the assessment of bone fracture risk, to date, its association with bone fracture risk in the general post-transplant population is not robust. Therefore, randomized controlled trials with bone fracture as the primary end point are crucial. The development of noninvasive bone markers in distinguishing bone turnover and bone mineralization status is also pivotal since skeletal lesions are heterogeneous in various organ transplantations. The elucidation of these underlying skeletal lesions is necessary for the consideration of selective treatment in this population.

KW - bone disease

KW - diagnosis

KW - epidemiology

KW - evaluation

KW - natural history

KW - pathogenesis

KW - prevention

KW - solid organ transplantation

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=79952731453&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952731453&partnerID=8YFLogxK

U2 - 10.1586/eem.10.86

DO - 10.1586/eem.10.86

M3 - Article

C2 - 30290452

AN - SCOPUS:79952731453

VL - 6

SP - 157

EP - 176

JO - Expert Review of Endocrinology and Metabolism

JF - Expert Review of Endocrinology and Metabolism

SN - 1744-6651

IS - 2

ER -