Transplantation Osteoporosis

Abstract

The number of transplants of solid organs such as the kidney, liver, heart, lung and pancreas is rising steadily together with an increase in the length of the patients’ survival times. For example, 98 % of kidney, 87 % of hepatic and 69 % of heart transplant patients live longer than a year. Half of all transplant patients eventually develop osteoporosis with fractures and this substantially reduces their quality of life. Even now, as shown by a recent study, the fracture rates remain intolerably high with 20–40 % of the patients. The major cause of the fractures is the bone disease which could have preceded the transplant and the subsequent conditions which follow it. In the absence of preventive measures, increased bone loss begins in the immediate postoperative period due to immobilisation and immunosuppression and continues thereafter due to many additional factors, such as possible neuropathy, reduced mobility, and lack of exercise, nutritional factors and above all the immunosuppressive therapy which the patients have to take. Patients who had diabetes before the transplant had significantly increased post-transplant fractures in the absence of prophylactic measures.