What are the risk factors for organ transplantation-related osteoporosis?

Updated: Jul 02, 2020
  • Author: Carmel M Fratianni, MD, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

Traditionally recognized risk factors for osteoporosis include white race, low body weight, estrogen or androgen deficiency, calcium and/or vitamin D deficiency, and thyroid hormone excess. In addition to these traditional risk factors, other risk factors are associated with solid organ transplantation.

Even before transplantation, bone homeostasis may be adversely influenced by the disease process or diseased organ itself (eg, liver, lung, or kidney failure). Moreover, patients are often exposed to therapeutic agents such as steroids, heparin, or loop diuretics, which promote negative calcium balance and bone loss. After transplantation, high-dose steroid therapy and immunosuppression further promote bone loss and fracture development. To quote Elizabeth Shane, a recognized leader in this field, "Immunosuppression insults an already compromised skeleton."

Long-term survival following organ transplantation has improved considerably. Because patients often wait 2 or more years before transplantation, this represents an opportunity to prevent further bone loss and to help restore what may already have been lost. The clinical focus should be to both optimize bone mass before transplantation and to prevent bone loss in the postoperative period. [8]

For other discussions on osteoporosis, see the topics Osteoporosis and Pediatric Osteoporosis, as well as Bone Markers in Osteoporosis and Nonoperative Treatment of Osteoporotic Compression Fractures.


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