Understanding Bone Damage After Kidney Transplantation: A Retrospective Monocentric Cross Sectional Analysis

M. Gregorini, G. Sileno, E. F. Pattonieri, V. Corradetti, M. Abelli, E. Ticozzelli, L. Scudeller, M. A. Grignano, P. Esposito, L. Bogliolo, A. Giacomoni, T. Rampino

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Kidney transplantation (KT) immunosuppression may induce bone tissue damage with bone mineral density (BMD) loss increasing bone fractures risk. Steroid therapy is considered the major player, but others factors are still under review. Patients and Methods We designed an observational retrospective cohort study to evaluate bone damage after KT. The prevalence of osteopenia, osteoporosis, bone fractures, and the associated risk factors were investigated. The following parameters were recorded before transplantation and at the last follow-up: demographic indexes, cumulative steroid dose (CSD), dialytic and transplantologic age, previous nephropathy, femoral and lumbar BMD, fractures, immunosuppressors, calcemia, phosphoremia, rejection episodes, estimated glomerular filtration rate, and parathyroid hormone and vitamin D levels. Stata software (Stata Corporation, College Station, Texas, United States) was used for the statistical analysis, to perform the Fisher's exact test, Kruskal-Wallis test, Student t test, as well as univariate and multivariate analyses. Results The analyzed cohort was composed of 297 patients (65.3% males and 34.7% females). Sixty percent of KT patients had normal BMD, 24% had osteopenia, and 15% had osteoporosis. Twelve percent were victims of bone fractures (8.4% minor, 2% femoral, and 1.7% vertebral). A significant correlation (P <.05) was observed for both osteopenia and osteoporosis with menopause, transplantologic age, CSD, previous glomerulonephritis, and mammalian target of rapamycin (mTOR) inhibitors treatment (imTOR). Conclusion This study confirms the correlation between CSD (both before and after transplantation) and post-transplantation bone damage. It also shows that a large fraction of these patients had normal BMD related with a low steroid dose in our protocols. This correlation between imTOR assumption and osteoporosis deserves attention and warrants further in vitro analyses to be performed.

Original languageEnglish
Pages (from-to)650-657
Number of pages8
JournalTransplantation Proceedings
Volume49
Issue number4
DOIs
Publication statusPublished - May 1 2017
Externally publishedYes

Fingerprint

Kidney Transplantation
Cross-Sectional Studies
Bone Density
Steroids
Osteoporosis
Metabolic Bone Diseases
Bone Fractures
Bone and Bones
Thigh
Transplantation
Bone Transplantation
Hypercalcemia
Sirolimus
Menopause
Glomerulonephritis
Parathyroid Hormone
Glomerular Filtration Rate
Vitamin D
Immunosuppression
Cohort Studies

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Understanding Bone Damage After Kidney Transplantation : A Retrospective Monocentric Cross Sectional Analysis. / Gregorini, M.; Sileno, G.; Pattonieri, E. F.; Corradetti, V.; Abelli, M.; Ticozzelli, E.; Scudeller, L.; Grignano, M. A.; Esposito, P.; Bogliolo, L.; Giacomoni, A.; Rampino, T.

In: Transplantation Proceedings, Vol. 49, No. 4, 01.05.2017, p. 650-657.

Research output: Contribution to journalArticle

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abstract = "Background Kidney transplantation (KT) immunosuppression may induce bone tissue damage with bone mineral density (BMD) loss increasing bone fractures risk. Steroid therapy is considered the major player, but others factors are still under review. Patients and Methods We designed an observational retrospective cohort study to evaluate bone damage after KT. The prevalence of osteopenia, osteoporosis, bone fractures, and the associated risk factors were investigated. The following parameters were recorded before transplantation and at the last follow-up: demographic indexes, cumulative steroid dose (CSD), dialytic and transplantologic age, previous nephropathy, femoral and lumbar BMD, fractures, immunosuppressors, calcemia, phosphoremia, rejection episodes, estimated glomerular filtration rate, and parathyroid hormone and vitamin D levels. Stata software (Stata Corporation, College Station, Texas, United States) was used for the statistical analysis, to perform the Fisher's exact test, Kruskal-Wallis test, Student t test, as well as univariate and multivariate analyses. Results The analyzed cohort was composed of 297 patients (65.3{\%} males and 34.7{\%} females). Sixty percent of KT patients had normal BMD, 24{\%} had osteopenia, and 15{\%} had osteoporosis. Twelve percent were victims of bone fractures (8.4{\%} minor, 2{\%} femoral, and 1.7{\%} vertebral). A significant correlation (P <.05) was observed for both osteopenia and osteoporosis with menopause, transplantologic age, CSD, previous glomerulonephritis, and mammalian target of rapamycin (mTOR) inhibitors treatment (imTOR). Conclusion This study confirms the correlation between CSD (both before and after transplantation) and post-transplantation bone damage. It also shows that a large fraction of these patients had normal BMD related with a low steroid dose in our protocols. This correlation between imTOR assumption and osteoporosis deserves attention and warrants further in vitro analyses to be performed.",
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AU - Corradetti, V.

AU - Abelli, M.

AU - Ticozzelli, E.

AU - Scudeller, L.

AU - Grignano, M. A.

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