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Osteoporosis and Fractures After Solid Organ Transplantation

A Nationwide Population-Based Cohort Study
  • Tung-Min Yu
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
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  • Cheng-Li Lin
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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  • Shih-Ni Chang
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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  • Fung-Chang Sung
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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  • Shih-Ting Huang
    Affiliations
    Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Division of Nephrology, Taichung Veteran General Hospital, Taichung, Taiwan
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  • Chia-Hung Kao
    Correspondence
    Correspondence: Address to Chia-Hung Kao, MD, Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
    Affiliations
    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
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      Abstract

      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. The overall hazard ratio (HR) of osteoporosis after SOT was 5.14 (95% CI, 3.13-8.43), and the HR of related fractures was 5.76 (95% CI, 3.80-8.74). The highest HRs were observed in male patients (HR, 7.09; 95% CI, 3.09-16.3) and in those aged 50 years or younger (HR, 7.38; 95% CI, 2.46-22.1). In addition, SOT patients without any comorbidities had a 9.03-fold higher risk of osteoporosis than non-SOT participants (HR, 9.03; 95% CI, 5.29-15.4). To compare the risk of osteoporosis and related fractures in different recipients of SOT, the highest risk of osteoporosis and fractures was noted in patients receiving lung transplantation, followed by other types of SOT.

      Conclusion

      We report high rates of metabolic bone disorders after SOT in chronic transplant patients over a long follow-up. Both underlying bone disorders before transplantation and use of immunosuppressant agents may contribute to bone disorders after transplantation.

      Abbreviations and Acronyms:

      BMD (bone mineral density), HR (hazard ratio), GC (glucocorticoid), ICD-9-CM (International Classification of Disease, Ninth Revision, Clinical Modification), NHIRD (Taiwan National Health Insurance Research Database), SOT (solid organ transplantation)
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