Post-Transplantation Bone Disease

Solid organ or stem cell transplantation is a well established procedure in the treatment of endstage diseases (renal disease, chronic liver failure, end-stage pulmonary disease, heart failure). Improved outcome for these patients has allowed us to study some of the complications. One of these is metabolic bone disease, which can hinder their long-term survival and quality of life. In this chapter we have review our current understanding of the pathophysiology of bone loss before and after solid organ transplantation, and review recommendations for the prevention and treatment of osteoporosis in patients accepted into organ transplantation programs. There are a number of risk factors contributing to bone loss in these patients: hypogonadism, vitamin D deficiency, malabsorption, low body weight, physical inactivity, excessive use of tobacco or alcohol and immunosuppressive therapy. Management of pretransplant risk factors has improved, resulting in better bone mineral density (BMD) levels before transplantation (Guichelaar et al., 2006). After transplantation, rapid and marked bone loss is observed in the first 3-6 months. The speed of the bone loss suggests that corticosteroids are heavily involved. Greater bone loss at vertebral and hip sites and high rates of incident fragility fractures have been reported (Leidig-Bruckner et al., 2001).