Download PDF
Osteologie 2017; 26(03): 139-144
DOI: 10.1055/s-0037-1622105
Kalzium-Phosphat-Stoffwechsel und Knochen
Schattauer GmbH

Knochenstoffwechsel nach Nierentransplantation

Bone metabolism after kidney transplantation
R. Fiedler
1   Klinik für Innere Medizin II, Universitätsklinikum der Martin-LutherUniversität Halle-Wittenberg, Halle (Saale)
› Author Affiliations
Further Information

Publication History

eingereicht: 10 July 2017

angenommen: 11 August 2017

Publication Date:
02 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Veränderungen im Knochenstoffwechsel nach soliden Organtransplantationen, insbesondere nach Nierentransplantation, der mit über 2000 Transplantationen pro Jahr häufigsten Form, stellen immer wieder eine Herausforderung für den klinisch tätigen Osteologen dar. Die Besonderheiten der Transplantationsosteopathie (TO) liegen zum einem in der multifaktoriellen Pathogenese (u. a. Medikamente, vor Transplantation bestehende Knochenstörungen, hormonelle und weitere Faktoren) und zum anderen in den eingeschränkten Leitlinien, da nur eine geringe Zahl an evidenzbasierten Studien berücksichtigt werden können. In diesem Übersichts-artikel wird auf die aktuellen Aspekte bezüglich der Ursachen, Leitlinien, Diagnostik und der Therapiemöglichkeiten eingegangen. Im Speziellen soll dabei die Bedeutung der Knochenbiopsie und der Osteodensitometrie als diagnostische Tools und die Behandlung der frakturgefährdeten Patienten im ersten Jahr nach der Transplantation hervorgehoben werden.

Summary

After solid organ transplantation changes of bone metabolism are often a challenge for an osteologist especially after kidney transplantation, which is the most common form with more than 2000 transplantations per year. The importance of (post)transplant osteo-pathy (TO) is characterized by a multifactorial pathogenesis (e. g. drugs, praetransplant existing bone diseases, hormonal and other factors) and otherwise by limited recommendations, if there are only few evidence-based studies considering for the guidelines. This review will report about causes, guideline recommendations, diagnostics and therapeutic options. In particular, the meaning of bone biopsy and osteoden-sitometry as diagnostic tools and the treatment of fracture-prone patients in the first year after kidney transplantation should be underlined.

Schlüsselwörter

Fraktur - Knochenbiopsie - Nierentransplantation - Osteodensitometrie - Osteopathie

Keywords

Bone biopsy - fracture - kidney transplantation - osteodensitometry - osteopathy
 

  • Literatur

  • 1 Deutsche Stiftung Organspende (DSO). Jahresbericht. 2016 https://www.dso.de/uploads/tx_dsodl/JB_2016_Web.pdf
    PubMed
  • 2 Maalouf N, Shane E. Osteoporosis after solid organ transplantation. J Clin Endocrinol Metab 2005; 90 (04) 2456-2465.
    CrossrefPubMedGoogle Scholar
  • 3 Kulak CA, Borba VZ, Junior JK, Custodio MR. Bone disease after transplantation: osteoporosis and fractures risk. Arq Bras Endocrinol Metab 2014; 58 (05) 484-492.
    CrossrefPubMedGoogle Scholar
  • 4 Lan G, Xie X, Peng L. et al. Current status of research on osteoporosis after solid organ transplantation: pathogenesis and management. BioMed Res Int 2015; ID: 413169.
    PubMedGoogle Scholar
  • 5 Cohen A, Sambrook P, Shane E. Management of bone loss after organ transplantation. J Bone Miner Res 2004; 19 (12) 1919-1932.
    CrossrefPubMedGoogle Scholar
  • 6 Luaces M, Crespo MGLeiro, Paniagua MJMartin. et al. Bone fractures after cardiac transplantation. Transplant Proc 2007; 39 (07) 2393-2396.
    CrossrefPubMedGoogle Scholar
  • 7 Hariman A, Alex C, Heroux A, Camacho P. Incidence of fractures after cardiac and lung transplantation: A single center experience. J Osteo-poros 2014; ID: 573041.
    Google Scholar
  • 8 Fahrleitner-Pammer A, Piswanger-Soelkner JC, Pieber TR. et al. Ibandronate prevents bone loss and reduces vertebral fracture risk in male cardiac transplant patients: A randomized double-blind, placebo-controlled trial. J Bone Miner Res 2009; 24 (07) 1335-1344.
    CrossrefPubMedGoogle Scholar
  • 9 Premaor MO, Das TK, Debiram I. et al. Fracture incidence after liver transplantation: results of a 10-year audit. Q J Med 2011; 104 (07) 599-606.
    CrossrefPubMedGoogle Scholar
  • 10 Kaemmerer D, Schmidt B, Lehmann G. et al. Monthly ibandronate for the prevention of bone loss in patients after liver transplantation. Transplant Proc 2012; 44 (05) 1362-1367.
    CrossrefPubMedGoogle Scholar
  • 11 Ferro CJ, Arnold J, Bagnall D. et al. Fracture risk and mortality post-kidney transplantation. Clin Transplant 2015; 29 (11) 1004-1012.
    CrossrefPubMedGoogle Scholar
  • 12 Helenius I, Remes V, Salminen S. et al. Incidence and predictors of fractures in children after solid organ transplantation: A 5-year prospective, population-based study. J Bone Miner Res 2006; 21 (03) 380-387.
    PubMedGoogle Scholar
  • 13 Epstein S, Stuss M. Transplantation osteoporosis. Pol J Endocrinol 2011; 62 (05) 472-485.
    Google Scholar
  • 14 Nikkel LE, Mohan S, Zhang A. et al. Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. Am J Transplant 2012; 12 (03) 649-659.
    CrossrefPubMedGoogle Scholar
  • 15 Campistol JM, Holt DW, Epstein S. et al. Bone metabolism in renal transplant patients treated with cyclosporine or sirolimus. Transplant Int 2005; 18 (09) 1028-1035.
    CrossrefPubMedGoogle Scholar
  • 16 Westenfeld R, Schlieper G, Wöltje M. et al. Impact of sirolimus, tacrolimus and mycophenolat mofetil on osteoclastogenesis – implications for posttransplantation bone disease. Nephrol Dial Transplant 2011; 26 (12) 4115-4123.
    CrossrefPubMedGoogle Scholar
  • 17 KDIGO 2017 Clinical Practice Guideline Update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017; 07 (01) 1-59.
    Article in Thieme ConnectGoogle Scholar
  • 18 Perrin P, Caillard S, Javier RM. et al. Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation. Am J Transplant 2013; 13 (10) 2653-2663.
    CrossrefPubMedGoogle Scholar
  • 19 Cunningham J. Posttransplantation bone disease. Transplantation 2005; 79 (06) 629-634.
    CrossrefPubMedGoogle Scholar
  • 20 DVO Leitlinie Osteoporose. 2014 Dachverband der osteologischen Fachgesellschaften (DVO). www.dv-osteologie.de
    PubMedGoogle Scholar
  • 21 Brandenburg VM, Ketteler M, Heussen N. et al. Lumbar bone mineral density in very long-term renal transplant recipients: Impact of circulating sex hormones. Osteoporos Int 2005; 16 (12) 1611-1620.
    CrossrefPubMedGoogle Scholar
  • 22 Jimenez S, Marcen R, Vaamonde C. et al. Bone fractures and lumbar mineral density after renal transplantation. A long-term cross-sectional study. Clin Transplant 2016; 30: 131-137.
    CrossrefPubMedGoogle Scholar
  • 23 Cruz DN, Wysolmerski JJ, Brickel HM. et al. Parameters of high turnover predict bone loss in renal transplant patients: A longitudinal study. Transplantation 2001; 72 (01) 83-88.
    CrossrefPubMedGoogle Scholar
  • 24 Naylor KL, Lix M, Hans D. et al. Trabecular bone score in kidney transplant recipients. Osteoporos Int 2016; 27 (03) 1115-1121.
    CrossrefPubMedGoogle Scholar
  • 25 Taweesedt PT, Disthabanchong S. Mineral and bone disorder after kidney transplantation. World J Transplant 2015; 05 (04) 231-242.
    Google Scholar
  • 26 Kalantar-Zadeh K, Molnar MZ, Kovesdy CP. et al. Management of mineral and bone disorder after kidney transplantation. Curr Opin Nephrol Hypertens 2012; 21 (04) 389-403.
    CrossrefPubMedGoogle Scholar
  • 27 Wissing KM, Broeders N, Moreno-Reyes R. et al. A controlled study of vitamin D3 to prevent bone loss in renal-transplant patients receiving low doses of steroids. Transplantation 2005; 79 (01) 108-115.
    CrossrefPubMedGoogle Scholar
  • 28 Josephson MA, Schumm LP, Chiu MY. et al. Calcium and calcitriol prophylaxis attenuates post-transplant bone loss. Transplantation 2004; 78 (08) 1233-1236.
    CrossrefPubMedGoogle Scholar
  • 29 El-Agroudy AE, El-Husseini AA, El-Sayed M. et al. A prospective randomized study for prevention of postrenal transplantation bone loss. Kidney Int 2005; 67 (05) 2039-2045.
    CrossrefPubMedGoogle Scholar
  • 30 Wang J, Yao M, Xu J. et al. Bisphosphonates for prevention of osteopenia in kidney-transplant recipients: a systematic review of randomized controlled trials. Osteoporos Int 2016; 27 (05) 1683-1690.
    CrossrefPubMedGoogle Scholar
  • 31 Cejka D, Benesch T, Krestan C. et al. Effect of teriparatide on early bone loss after kidney transplantation. Am J Transplant 2008; 08 (09) 1864-1870.
    CrossrefPubMedGoogle Scholar
  • 32 Nogueira EL, Costa AC, Santana A. et al. Teriparatide efficacy in the treatment of severe hypocalcemia after kidney transplantation in parathyroidectomized patients: a series of five case reports. Transplantation 2011; 92 (03) 316-320.
    CrossrefPubMedGoogle Scholar
  • 33 Rote Hand Brief Calcitonin vom 15.08.2012. http://www.akdae.de/Arzneimittelsicherheit/RHB/Archiv/2012/20120815.pdf
  • 34 Perrin P, Kiener C, Javier RM. et al. Recent changes in chronic kidney disease-mineral and bone disorders (CKD-MBD) and associated fractures after kidney transplantation. Transplantation 2017; 101 (08) 1897-1905.
    CrossrefPubMedGoogle Scholar
  • 35 Cruzado JM, Moreno P, Torregrosa JV. et al. A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism. J Am Soc Nephrol 2016; 27 (08) 2487-2494.
    CrossrefPubMedGoogle Scholar
  • 36 Collaud S, Staub-Zähner T, Trombetti A. et al. Increase in bone mineral density after successful parathyroidectomy for tertiary hyperparathyroidism after renal transplantation. World J Surg 2008; 32 (08) 1795-1801.
    CrossrefPubMedGoogle Scholar
  • 37 Rudser KD, de Boer IH, Dooley A. et al. Fracture risk after parathyroidectomy in chronic hemodialysis patients. J Am Soc Nephrol 2007; 18 (08) 2401-2407.
    CrossrefPubMedGoogle Scholar
  • 38 Bonani M, Frey D, Brockmann J. et al. Effect of twice-yearly denosumab on prevention of bone mineral density loss in de novo kidney transplant recipients: A randomized controlled trial. Am J Transplant 2016; 16 (06) 1882-1891.
    CrossrefPubMedGoogle Scholar
  • 39 Bonani M, Meyer U, Frey D. et al. Effect of denosumab on peripheral compartmental bone density, microarchitecture and estimated bone strength in de novo kidney transplant recipients. Kidney Blood Press Res 2016; 41 (05) 614-622.
    CrossrefPubMedGoogle Scholar