Osteoporosis and osteopenia in patients after the organ transplantation
Background: Survival of patients after the transplantation (Tx) of solid organs is improving. Osteoporosis and bone fractures belong to their long-term complications. The contributing factors are disturbances of bone metabolism in pre-transplant period and immunosuppressive therapy including corticosteroids after the transplantation.
Patients and methods: We investigated the prevalence of osteoporosis and osteopenia in 248 diabetic patients after the Tx of kidney for renal failure due to diabetic nephropathy and we compared them with 232 non-diabetic patients after the kidney Tx and 70 patients after the liver Tx. The bone loss was diagnosed with densitometry (DEXA) using Lunar Prodigyapparatus. In diabetic patient we followed some characteristics of bone metabolism: Ca, P, parathormone (PTH), osteocalcin, 1,25(OH)2 D3, 25OHD3, ICTP and bone ALP (BALP).
Results: In diabetic patients after Tx was osteopenia present in 50% and osteoporosis in 26%. Patients with Tx for non-diabetic nephropathy had osteopenia in 45% and osteoporosis in 28%. Patients after liver Tx showed osteopenia in 43% and osteoporosis in 18%. In diabetic patients the mean levels bone metabolism characteristics were: 2.38±0.12 mmol/l, P 1.12±0.21 mmol/l, ALP: 1.52±0.59 μkat/l, creatinine: 121.34±39.4 μmol/l, osteocalcin 61.0±51.3 μg/l, PTH 11.17±7.3 pmol/l, KALP 14.42±5.5 μg/l, ICTP 10.7±6.5 μg/l, 1,25(OH)2D3 vit. 58.8±27.8 ng/l, 25 OHD3 vit. 18.8±7.4 μg/l. Low levels of D vitamin were identified in 63% of diabetic patients.
Conclusions: In this study of patients with organ transplantation we found increased prevalence osteopenia and osteoporosis. The highest percentage of diminished bone density was present in diabetics (76%), than in non-diabetic patients with kidney Tx (73%) and lowest among patients after liver Tx (61%). Diabetic patients had frequently impaired characteristics of bone metabolism and low D vitamin levels.