Post-Transplant Bone Mineral Disease
Özet
Kidney transplantation is associated with mineral and bone disorders that contribute to an increased risk of fractures and, consequently, to higher morbidity and mortality. Post-transplant mineral and bone disorders encompass not only the persistent effects of chronic kidney disease–mineral and bone disorder present before transplantation, but also new pathophysiological processes driven by persistent hyperparathyroidism, elevated fibroblast growth factor-23 levels, vitamin D deficiency, calcium–phosphate imbalance, immunosuppressive therapies, and changes in graft function. The assessment of bone disorder in kidney transplant recipients includes the identification of clinical risk factors, monitoring of biochemical parameters, evaluation of bone mineral density by dual-energy X-ray absorptiometry, and, in selected cases, bone biopsy. However, currently available diagnostic tools have certain limitations in precisely determining fracture risk and characterizing the type of bone turnover. Primary management strategies include non-pharmacological measures- such as reducing fall risk, promoting exercise, and modifiying lifestyle- alongside adequate calcium and vitamin D supplementation. Individualized treatment options may include bisphosphonates, denosumab, calcimimetics, osteoanabolic agents, and parathyroidectomy. Evidence remains limited regarding the long-term effects of these interventions on fracture outcomes, graft safety, and their efficacy across different patterns of bone turnover. This review aims to provide a comprehensive overview of the current literature on the pathophysiology, epidemiology, risk factors, diagnostic approach, and available treatment options for mineral and bone diseases after kidney transplantation.
Referanslar
Teh JW, Mac Gearailt C, Lappin DWP. Post-Transplant Bone Disease in Kidney Trans- plant Recipients: Diagnosis and Management. International Journal of Molecular Sciences. 2024;25(3):1859. doi:https://doi.org/10.3390/ijms25031859
Afsar B, Afsar RE, Caliskan Y, et al. The Relationship between Sclerostin and Kidney Trans- plantation Mineral Bone Disorders: A Molecule of Controversies. Calcified Tissue Internatio- nal. 2024;115(4):339-361. doi:https://doi.org/10.1007/s00223-024-01261-w
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clin- ical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 2024;105(4S):S117-S314. doi:https://doi.org/10.1016/j.kint.2023.10.018
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDI- GO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney In- ternational Supplements (2011). 2017;7(1):1-59. doi:https://doi.org/10.1016/j.kisu.2017.04.001
Torregrosa JV, Ferreira AC, Cucchiari D, et al. Bone Mineral Disease After Kidney Transplan- tation. Calcified Tissue International. 2021;108(4):551-560. doi:https://doi.org/10.1007/s00223- 021-00837-0
Kurnool S, Shah N, Ekanayake P. Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach. Therapeutic Advances in Endocrinology Metabolism. 2025;16:20420188251347351. doi: https:// 10.1177/20420188251347351
Wolf M, Weir MR, Kopyt N, et al. A Prospective Cohort Study of Mineral Metabolism Af- ter Kidney Transplantation. Transplantation. 2016;100:184–193. doi:https://10.1097/ TP.0000000000000823.
Kovvuru K, Kanduri SR, Vaitla P, et al. Risk Factors and Management of Osteoporosis Post-Transplant. Medicina (Kaunas). 2020;56(6):302. doi: https:// 10.3390/medicina56060302
Kim KJ, Ha J, Kim SW, et al. Bone Loss after Solid Organ Transplantation: A Review of Or- gan-Specific Considerations. Endocrinology and Metabolism (Seoul). 2024;39(2):267-282. doi: https:// 10.3803/EnM.2024.1939
Amiri FS, Khatami MR. Fibroblast Growth Factor 23 in Postrenal Transplant: An Often For- gotten Hormone. Experimental and Clinical Transplantation. 2016;14(6):606-616. doi: https:// 10.6002/ect.2016.0025
Bellorin-Font E, Rojas E, Martin KJ. Bone Disease in Chronic Kidney Disease and Kidney Transplant. Nutrients. 2022;15(1):167. doi: https:// 10.3390/nu15010167.
Khairallah P, Nickolas TL. Bone and Mineral Disease in Kidney Transplant Recipients. Clini- cal Journal of the American Society of Nephrology. 2022;17(1):121-130. doi: https:// 10.2215/ CJN.03410321
Palmer SC, Chung EY, McGregor DO, et al. Interventions for preventing bone disease in kid- ney transplant recipients. Cochrane Database of Systematic Reviews. 2019;10(10):CD005015. doi: https:// 10.1002/14651858.CD005015.pub4
Cowan AC, Solo K, Lebedeva V, et al. Incidence, Prediction, and Prevention of Fractures After Kidney Transplantation: A Systematic Review Protocol. Canadian Journal of Kidney Health and Disease. 2024;11:20543581241306799. doi: https:// 10.1177/20543581241306799
Kuppachi S, Cheungpasitporn W, Li R, et al. Kidney transplantation, immunosuppression and the risk of fracture: clinical and economic implications. Kidney Medicine. 2022;4(6):100474. doi: https:// 10.1016/j.xkme.2022.100474.
Jia L, Chao S, Yang Q, et al. The comprehensive incidence and risk factors of fracture in kidney transplant recipients: a meta-analysis. Nephrology (Carlton). 2024;29(9):588-599. doi: https:// 10.1111/nep.14301.
Ketteler M, Evenepoel P, Holden RM, et al. Chronic kidney disease-mineral and bone disor- der: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney international. 2025;107(3):405-423. doi: https:// 10.1016/j.kint.2024.11.013
Georgopoulou GA, Papasotiriou M, Ntrinias T, et al. Impact of bisphosphonate treat- ment on bone mineral density after kidney transplant. World Journal of Transplantation. 2024;14(3):92335. doi: https:// 10.5500/wjt.v14.i3.92335
Leng Y, Yu X, Yang Y, et al. Efficacy and safety of medications for osteoporosis in kidney trans- plant recipients or patients with chronic kidney disease: A meta-analysis. Journal of Investigati- ve Medicine. 2023;71:760–772. doi: https:// 10.1177/10815589231184215.
Toth-Manikowski SM, Francis JM, Gautam A, et al. Outcomes of bisphosphonate therapy in kidney transplant recipients: a systematic review and meta-analysis. Clinical Transplantation. 2016;30(9):1090-1096. doi: https:// 10.1111/ctr.12792.
Lip A, Warias A, Shamseddin MK, et al. Effect of bisphosphonates on bone health in adult renal transplant patients: beyond the first year posttransplant—a systematic review and meta-anal- ysis. Canadian Journal of Kidney Health and Disease. 2019;6: 2054358119858014. doi: https:// 10.1177/2054358119858014.
Kahwaji JM, Yang SJ, Sim JJ, et al. Bisphosphonate Use after Kidney Transplantation Is Asso- ciated with Lower Fracture Risk. Clinical Journal of the American Society of Nephrology. Pub- lished online November 5, 2024. doi: https:// 10.2215/CJN.0000000591
Song SH, Choi HY, Kim HY, et al. Effects of bisphosphonates on long-term kidney transplanta- tion outcomes. Nephrology Dialysis Transplantation. 2021;36(4):722-729. doi: https:// 10.1093/ ndt/gfaa371
Zhu P, Yang T, Le J, et al. Efficacy of denosumab on bone metabolism and bone mineral density in renal transplant recipients: a systematic review and meta-analysis. Transplantation Reviews (Orlando). 2023;37(4):100793. doi: https:// 10.1016/j.trre.2023.100793.
Vetrano D, Aguanno F, Passaseo A, et al. Efficacy and safety of teriparatide in kidney transplant recipients with osteoporosis and low bone turnover: a real-world experience. International Urology and Nephrology. 2025;57(6):1965-1975. doi: https:// 10.1007/s11255-025-04383-8
Cejka D, Benesch T, Krestan C, et al. Effect of teriparatide on early bone loss after kidney transplantation. American Journal of Transplantation. 2008;8(9):1864-1870. doi: https:// 10.1111/j.1600-6143.2008.02327.x
Tominaga A, Wada K, Kato Y, et al. Romosozumab for managing severe osteoporosis in patients undergoing kidney transplantation: a retrospective case series. JBMR Plus. 2025;9(6):ziaf049. doi: https:// 10.1093/jbmrpl/ziaf049
