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- Title
Long-term follow-up study on bone mineral density and fractures after simultaneous pancreas-kidney transplantation.
- Authors
Smets, Yves F.C.; de Fijter, Johan W.; Ringers, Jan; Lemkes, Herman H.P.J.; Hamdy, Neveen A.T.
- Abstract
Long-term follow-up study on bone mineral density and fractures after simultaneous pancreas-kidney transplantation.Background.In type 1 diabetic patients with end-stage renal failure, low bone mass is prevalent and the incidence of fractures high after simultaneous pancreas kidney transplantation (SPK). Data are scarce on preexisting skeletal morbidity or the long-term effects of SPK on bone mass and risk of fractures.Methods.We conducted a prospective study addressing these issues in 19 consecutive SPK recipients before and at 3, 6, and 12 months, and 2.5 to 4 years after establishment of graft function.Results.Prior to transplantation, 13 patients (68%) had hyperparathyroidism, 7 of whom had osteoporosis. Mean bone mineral density (BMD) was significantly lower at the femoral neck than at the lumbar spine (T-scores−2.0± 0.89 vs.−0.66± 0.84). There was a significant decrease in BMD at both lumbar spine and femoral neck at 6 months post-transplantation (−6.0± 5.4% and−6.9± 4.3%, respectively). No further loss was observed in the following 6 months. At 1 year post-transplantation, 9 patients had osteoporosis associated with hyperparathyroidism in 8, and none had sustained a clinical fracture. A significant albeit small increase in BMD was observed 6 months after start of alfacalcidol 0.25μg/day. At end-evaluation, osteoporosis and hyperparathyroidism persisted in the patients in whom it was documented at 1 year. Five patients who had lower BMD at the femoral neck pretransplantation sustained a clinical fracture.Conclusion.Cortical osteoporosis is prevalent in SPK recipients at the time of transplantation, progresses early post-transplantation, and is associated with relatively high incidence of fractures. Reversal of persistent hyperparathyroidism with the use of alfacalcidol may contribute to a decrease in skeletal morbidity.
- Subjects
ENDOCRINE diseases; PANCREATIC diseases; KIDNEY diseases; PEOPLE with diabetes; TRANSPLANTATION of organs, tissues, etc.; INTERNAL medicine
- Publication
Kidney International, 2004, Vol 66, Issue 5, p2070
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1111/j.1523-1755.2004.00986.x