J Bone Miner Res 2017 May 1;32(5):1116-1125. Epub 2017 Mar 1.

Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.

Chronic renal, liver, and heart failure in children associates with multiple skeletal complications. Increased fracture incidence often persists after transplantation and could be related to alterations in bone material properties. In the present cohort study we evaluated bone mineralization density distribution (BMDD) by quantitative backscattered electron imaging (qBEI) in 23 pediatric solid organ allograft recipients with suspected osteoporosis. Read More

FP Essent 2016 Nov;450:22-27

Department of Family Medicine Louisiana State University School of Medicine, 1542 Tulane Ave, New Orleans, LA 70112.

Nearly 31,000 US patients received solid organ transplants in 2015 and the number is increasing. Care of transplant recipients includes management of a variety of common posttransplantation issues. Skin cancers are common because of immunosuppression and require skin examinations at intervals. Read More

Respir Med 2016 Aug 7;117:103-8. Epub 2016 Jun 7.

Department of Cardiothoracic Transplantation, Institute of Transplantation, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, United Kingdom; Institute of Cellular Medicine, Newcastle Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom. Electronic address:

Background: Lung transplant recipients have reduced long-term survival compared with other solid organ recipients. There is a lack of published data on the characteristics of very long term survivors.

Methods: We describe the demographics, clinical history and post-procedure function of all lung transplant recipients who have survived greater than 20 years at our centre. Read More

Biomed Res Int 2015 15;2015:413169. Epub 2015 Nov 15.

Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha 410011, China.

Improved survival following organ transplantation has brought to the forefront some long-term complications, among which osteoporosis and associated fractures are the major ones that adversely affect the quality of life in recipients. The pathogenesis of osteoporosis in transplant recipients is complex and multifactorial which may be related to increased bone resorption, decreased bone formation, or both. Studies have shown that the preexisting underlying metabolic bone disorders and the use of immunosuppressive agents are the major risk factors for osteoporosis and fractures after organ transplantation. Read More

Osteoporos Int 2016 Apr 16;27(4):1425-40. Epub 2015 Oct 16.

Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA.

The prevention and treatment of osteoporosis is an increasingly important topic in the solid organ transplant (SOT) population. Compared to the general population, these patients are at an elevated risk of developing osteoporosis due to progressive disease, lifelong immunosuppressant therapy, and malnutrition. As patients live longer after transplant, chronic disease management is increasingly more important. Read More

Int J Endocrinol 2015 27;2015:280164. Epub 2015 Jul 27.

Department of Respiratory Medicine, Second Xiangya Hospital of Central South University, Changsha 410011, China.

Osteoporosis (OP) has emerged as a frequent and devastating complication of organ solid transplantation process. Bone loss after organ transplant is related to adverse effects of immunosuppressants on bone remodeling and bone quality. Many factors contribute to the pathogenesis of OP in transplanted patients. Read More

Mayo Clin Proc 2014 Jul 5;89(7):888-95. Epub 2014 May 5.

Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address:

Objective: To investigate the incidence of bone disorders after solid organ transplantation (SOT).

Participants And Methods: We used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex- and age- matched control subjects between January 1, 1997, and December 31, 2010, to compare the incidence and risk of bone disorders between groups.

Results: Recipients of SOT had a significantly higher incidence of osteoporosis and related fractures compared with the non-SOT group. Read More

Pediatr Nephrol 2014 Aug 23;29(8):1431-40. Epub 2014 Feb 23.

Bone and Cartilage Research Unit (BCRU), University of Eastern Finland, POB 1627, Mediteknia Building, 70211, Kuopio, Finland,

Background: Organ transplantation may lead to secondary osteoporosis in children. This study characterized bone histomorphometric findings in pediatric solid organ transplant recipients who were assessed for suspected secondary osteoporosis.

Methods: Iliac crest biopsies were obtained from 19 children (7. Read More

Endocr Pract 2013 Jan-Feb;19(1):120-8

Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, IL 60153, USA.

Objective: To provide an updated review of several causes of secondary osteoporosis as well as screening recommendations for these disorders.

Methods: We conducted an updated review of the literature published since 2006 on secondary causes of osteoporosis. This information has been added to the relevant data published between 1990 and 2006, which was included in our prior review from 2006. Read More

Minerva Endocrinol 2012 Sep;37(3):221-31

Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil.

Osteoporosis and high risk of fractures have emerged as frequent and devastating complications of organ solid transplantation process. Bone loss after organ transplant is related to adverse effects of immunosuppressive drugs on bone remodeling and bone quality. Many factors contribute to the pathogenesis of osteoporosis in transplanted patients. Read More

Clin Kidney J 2012 Feb 28;5(1):13-6. Epub 2012 Jan 28.

Division of Musculoskeletal Radiology, Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA.

Bone disease remains a major cause of morbidity after renal transplantation. Post-transplant osseous complications include osteoporosis and osteonecrosis, both historically associated with glucocorticoids, and a newer syndrome of bone pain associated with calcineurin inhibitors. Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow transplantation. Read More

Ageing Res Rev 2012 Jan 1;11(1):181-7. Epub 2011 Jul 1.

Department of Surgery, Division of Transplantation, Medical University Graz, Austria.

Introduction: Many transplant studies in elderly patients focus on survival and mortality rates. It was the aim of this review to evaluate publications dealing with individual patient performance and independence.

Methods: The literature search included all articles retrievable for the hit "transplantation in elderly recipients" between 1960 and 2010. Read More

Transplantation 2011 Jul;92(1):106-11

Department of Medicine, Clinic of Internal Medicine, Section D, University of Verona, Verona, Italy.

Background: Bone disease is one of the major complications of solid organ transplantation, causes considerable morbidity, and most patients are treated with immunosuppressant drugs after graft. The majority of studies reported rapid bone loss and an increased incidence of fractures after transplantation. The aim of our study was to evaluate osteoporosis and fracture prevalence, bone metabolism, and the effect of immunosuppressant agents on bone after heart transplantation. Read More

Osteoporos Int 2011 Jul 5;22(7):2107-18. Epub 2011 Jan 5.

Department of Medicine, Columbia University Medical Center, 630 West 168th Street, PH8-864, New York, NY 10032, USA.

Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Read More

Transplantation 2010 Nov;90(9):1006-10

Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Munich, Germany.

Background: Impaired bone health has been advocated after solid organ transplantation in adult and pediatric patients. Osteoporosis accompanied by fractures have been found also in heart transplantation recipients.

Methods: Parameters of bone mineral density (BMD) and bone geometry were measured in 34 patients (15 females, mean age: 14. Read More

Expert Rev Respir Med 2009 Aug;3(4):403-23

Division of Pulmonary and Critical Care Medicine and the Cystic Fibrosis/Pulmonary Research and Treatment Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7524, USA.

Lung transplantation has become a proven therapeutic option for patients with end-stage lung disease, extending life and providing improved quality of life to those who otherwise would continue to be breathless and oxygen-dependent. Over the past 20 years, considerable experience has been gained in understanding the multitude of medical and surgical issues that impact upon patient survival. Today, clinicians have an armamentarium of tools to manage diverse problems such as primary graft dysfunction, acute and chronic allograft rejection, airway anastomotic issues, infectious complications, renal dysfunction, diabetes and osteoporosis, hematological and gastrointestinal problems, malignancy, and other unique issues that confront immunosuppressed solid organ transplant recipients. Read More

Clin Transplant 2010 Sep-Oct;24(5):E145-52

Section of Nephrology, Department of Medicine, Rikshospitalet, Oslo, Norway.

Post-transplant bone disease is common in solid organ recipients; however, there is limited information on their pre-transplant bone status. We aimed to compare bone mineral density (BMD) in different categories of patients with end-stage organ failure awaiting transplantation (Tx) in Norway. Overall 291 adult patients were enrolled, including 60, 84, 81 and 66 patients with end-stage lung, liver, kidney and heart failure, respectively. Read More

Transplantation 2010 Feb;89(4):458-64

Medical Department, Rikshospitalet, Oslo University Hospital, Oslo, Norway.

Background: Osteoporosis is a problem after transplantation. Studies since the last year indicate that vitamin K plays a role in optimal bone health. The aim of this randomized, double blind, prospective longitudinal study was to investigate the effect of a dietary supplement with vitamin K2 (180 microg menakinon-7) on bone mass, the first year after lung and heart transplantation. Read More

Open Orthop J 2009 May 15;3:27-31. Epub 2009 May 15.

Department of Orthopaedic Surgery, Sundsvall Hospital, S-851 86 Sundsvall, Sweden.

Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. Read More

Dtsch Arztebl Int 2009 Feb 27;106(9):148-56. Epub 2009 Feb 27.

Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.

Background: The postoperative management following solid organ transplantation requires close cooperation between family doctors, internists, the local hospital, and the transplant center.

Methods: Selective analysis of current national and international guidelines and relevant review articles.

Results/conclusion: In the early phase post transplantation, aftercare involves inpatient treatment and outpatient or inpatient rehabilitation with the aim of complete social and professional reintegration. Read More

Curr Pharm Des 2007 ;13(35):3622-36

Department of Clinical Biochemistry, Royal Free Hospital, London, UK.

Statins are pluripotent agents exhibiting multiple non-lipid-lowering actions. Besides their established role in the management of hypercholesterolemia, statins may also have beneficial actions in other pathological conditions, namely: a) osteoporosis and osteoporosis-related bone fractures, b) cancer, c) solid organ transplantation, d) cerebrovascular events (transient ischemic attack and stroke episodes), e) various neurological disorders, such as Alzheimer's disease, Parkinson's disease and multiple sclerosis, f) cardiac arrhythmias and heart failure, g) renal diseases, h) rheumatoid arthritis, i) autoimmune diseases, j) sepsis, and k) allergic asthma. We reviewed the literature searching for studies that support or oppose the use of statins in each proposed indication. Read More

Ann N Y Acad Sci 2007 Nov 13;1116:216-26. Epub 2007 Sep 13.

Mount Sinai Bone Program and Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.

Here we briefly review our studies that have unraveled an important role for the calcium- and calmodulin-sensitive enzyme calcineurin (CN) in bone remodeling. We find that the genetic deletion of the calcineurin Aalpha isoform results in osteoporosis, which is recapitulated in humans following calcineurin inhibitor therapy widely used after solid organ transplantation. Mechanistically, however, while both calcineurin inhibitors cyclosporine and tacrolimus initially stimulate osteoclastic bone resorption in humans, the predominant feature in the CNAalpha null mouse is a profound reduction in bone formation. Read More

J Bone Miner Res 2007 Dec;22(12):1878-84

Pharmacoepidemiology and Pharmacoeconomics Research Unit, CHUM-Hôtel-Dieu, Montreal, Quebec, Canada.

Unlabelled: To assess the risk of fractures after a solid organ transplantation among diabetic versus nondiabetic patients, we conducted a nested case-control study. Pretransplant diabetes was associated with a 2-fold increase in post-transplant fractures.

Introduction: Diabetes has been associated with osteoporosis in the general population. Read More

Harefuah 2006 Dec;145(12):904-7, 941

Department of Orthopaedic Surgery, Western Galilee Hospital, Nahariya, Israel.

Patients that have had organ transplantation receive immunosuppressive therapy to prevent organ rejection. Along with this therapy comes a higher incidence of osteoporosis, which may lead to an increased frequency of fractures in post-transplant patients. This article presents three patients who underwent organ transplantation and had subsequent fractures: subcapital fracture of the femoral neck treated with hemiarthroplasty of the hip, in a patient 8 years post cardiac transplantation; minimally displaced intertrochanteric fracture treated by percutaneous pinning, in a patient one year post lung transplantation; minimally displaced subcapital fracture treated by percutaneous pinning, in a patient 3 months post liver transplantation. Read More

J Clin Densitom 2006 Oct-Dec;9(4):469-74. Epub 2006 Jul 28.

Department of Endocrinology, University Hospital 12 de Octubre, Madrid, Spain.

Bone loss is one of the most common complications after solid-organ transplantation, but it is frequently under-diagnosed. Our purpose was to evaluate quantitative ultrasound of calcaneus (QUS) in comparison with dual-energy X-ray absorptiometry (DXA) to identify transplant recipients with osteoporosis. We have cross-sectionally evaluated 140 transplant recipients (85 liver and 55 cardiac transplantations; mean age: 53. Read More

Drugs Aging 2006 ;23(10):781-93

Transplant Center/Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

New-onset diabetes mellitus in a previously non-diabetic transplant recipient is a serious adverse event that confers significant morbidity and mortality. The most significant consequences of post-transplant diabetes mellitus (PTDM) in solid organ transplant recipients include decreased patient and graft survival, an increased risk of infectious complications, and morbid cardiovascular events. The development of PTDM in the elderly is of particular concern because this group is already at increased risk of progression of cardiovascular disease. Read More

Spine J 2006 Sep-Oct;6(5):494-9. Epub 2006 Jul 24.

Department of Neurosurgery, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA.

Background Context: Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs.

Purpose: To explore whether balloon kyphoplasty is an effective treatment for VCF that develop in solid organ transplant recipients. Read More

Endocr Pract 2006 Jul-Aug;12(4):436-45

Division of Endocrinology, Loyola University Medical Center, Maywood, Illinois 60153, USA.

Objective: To review several causes of secondary osteoporosis as well as screening recommendations for underlying disorders.

Methods: We conducted a review of the literature on many of the causes of osteoporosis that have been published during the past 15 years, focusing on those sources available from 2000 through the present. Indeed, more than two-thirds of the articles that we reviewed were printed during the past 6 years. Read More

Arq Bras Endocrinol Metabol 2005 Jun 16;49(3):369-77. Epub 2006 Mar 16.

Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ.

Osteoporosis is a common complication following kidney, heart, liver and lung transplantation. Immunosuppressive regimens to prevent graft rejection after transplantation commonly include glucocorticoids, cyclosporin A and tacrolimus which are detrimental to bone and mineral homeostasis and are superimposed on an already compromised skeleton. Additional factors likely to contribute to post-transplantation osteoporosis pathogenesis are vitamin D insufficiency, secondary hyperparathyroidism and hypogonadism. Read More

Transplant Proc 2006 Jan-Feb;38(1):165-7

Department of Transplant Medicine and Nephrology, Medical University of Warsaw, ul. Nowogrodzka 59, 02-006 Warsaw, Poland.

Introduction: Rapid bone loss and fractures occur early after solid organ transplantation. We examined the preliminary results of a prospective study evaluating the efficacy of prophylactic use of bisphosphonates in renal allograft recipients.

Methods: Bone mineral density (BMD) was measured at the lumbar spine and the hip by dual energy X-ray absorptiometry at 1, 6, 12 months. Read More

BMC Pulm Med 2006 Feb 6;6. Epub 2006 Feb 6.

Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, Canada.

Background: Systemic inflammation is associated with various complications in chronic obstructive pulmonary disease including weight loss, cachexia, osteoporosis, cancer and cardiovascular diseases. Inhaled corticosteroids attenuate airway inflammation, reduce exacerbations, and improve mortality in chronic obstructive pulmonary disease. Whether inhaled corticosteroids by themselves or in combination with a long-acting beta2-adrenoceptor agonist repress systemic inflammation in chronic obstructive pulmonary disease is unknown. Read More

Eur Spine J 2006 Aug 10;15(8):1230-8. Epub 2006 Jan 10.

Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, 00029 HUS, Helsinki, Finland.

A review of the current literature reveals no systematic analyses of the results of surgical correction of spinal deformity after pediatric organ transplantation. We therefore evaluated clinical and radiographic outcomes of spinal deformity correction after solid organ transplantation in childhood and adolescence. All 211 cases of heart, liver, and kidney transplantations performed in children in our country were reviewed. Read More

J Clin Endocrinol Metab 2005 Jul 29;90(7):3877-85. Epub 2005 Mar 29.

Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, FIN-00290 Helsinki, Finland.

Context: In controlled studies, bisphosphonates have been used to prevent bone loss after solid organ transplantations but not in conjunction with stem cell transplantation (SCT).

Objective: The objective of the study was to test whether additional iv pamidronate would prevent bone loss associated with SCT more effectively than the combination of calcium, vitamin D, and sex steroid replacement therapy alone.

Setting: The study was carried out at the Helsinki University Central Hospital. Read More

J Clin Endocrinol Metab 2005 Apr 28;90(4):2456-65. Epub 2004 Dec 28.

Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8-864, 630 West 168th Street, New York, New York 10032, USA.

With the rapid increase in the number of organs transplanted worldwide and the improved survival of transplant recipients, osteoporosis has emerged as a frequent complication of the transplantation process. In the past decade, the wider recognition of transplantation-related osteoporosis has led to a decrease in the risk of fracture for the individual patient. Nonetheless, fracture rates remain unacceptably high in transplant recipients. Read More

Clin Transplant 2004 Oct;18(5):613-8

Department of Internal Medicine, University of Nebraska Medical Center, 983020 Nebraska Medical Center, Omaha, NE 68198-3020, USA.

Background: Solid organ transplant recipients, particularly simultaneous pancreas kidney recipients, are at high fracture risk. We tested whether quantitative ultrasonography (QUS) of the heel predicts bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) in solid organ transplant recipients.

Methods: Thirty-eight transplant recipients (22 Female/16 Male) were studied. Read More

Osteoporos Int 2003 Aug 8;14(8):617-30. Epub 2003 Aug 8.

College of Physicians & Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA.

Organ transplantation has become increasingly common as a therapy for end-stage renal, liver, cardiac and pulmonary disease. The population of patients who have survived organ transplantation has grown dramatically over the last 2 decades. Although organ transplant recipients now benefit from greatly improved survival, long-term complications of organ transplantation, such as osteoporosis, adversely affect quality of life and must be addressed. Read More

Liver Transpl 2003 Apr;9(4):321-30

Department of Medicine, University of Cambridge School of Clinical Medicine, United Kingdom.

Osteoporosis remains a serious potential complication of liver transplantation, although its incidence may be significantly reduced by the use of lower doses of glucocorticoids. Additional factors likely to contribute to its pathogenesis include other immunosuppressive agents, particularly cyclosporin A and FK506, vitamin D insufficiency, secondary hyperparathyroidism, hypogonadism and pre-existing bone disease. Bone density assessment and spinal X-rays should be performed before transplantation to assess subsequent fracture risk and vitamin D and gonadal status assessed. Read More

Transpl Int 2002 Jun 16;15(6):290-5. Epub 2002 Apr 16.

Department of Medicine, Box 157, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge CB2 2QQ, UK.

Osteoporosis is a common and serious complication of solid organ transplantation. Effective therapeutic regimens have not been established but evidence that increased bone turnover is responsible for bone loss early after transplantation provides a rationale for the use of anti-resorptive agents in the peri-operative period. We have examined the effects of a single pre-operative infusion of pamidronate, 60 mg, on bone remodelling and turnover in a prospective study of 12 patients, four male and eight female aged 19-61 years, with chronic liver disease, who formed a subgroup of a larger randomised controlled single-blind study. Read More

Med Clin (Barc) 2000 May;114(20):772-3

Calcif Tissue Int 1997 Apr;60(4):343-7

Rheumatology Section, Hospital Universitario de La Princesa, C/Diego de León 62, 28006 Madrid, Spain.

Osteoporosis is a common disease among patients undergoing transplantation. Its prevalence and complications have been well described in solid organ recipients, especially kidney, liver, and heart. However, studies in bone marrow transplantation (BMT) are scarce. Read More

Calcif Tissue Int 1991 ;49 Suppl 2:S2-6

Sandoz Research Institute, East Hanover, NJ 07936.

Injectable salmon calcitonin has been in use in the United States for more than a decade for the treatment of patients with postmenopausal osteoporosis, Paget's disease, and hypercalcemia. Sandoz Pharmaceuticals Corp. is currently in the process of developing a nasal formulation of salmon calcitonin. Read More