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)To read this article in full you will need to make a payment
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References
- Osteoporosis after solid organ transplantation.J Clin Endocrinol Metab. 2005; 90: 2456-2465
- Alcohol-induced bone disease in the absence of severe chronic liver damage.J Bone Miner Res. 1994; 9: 825-831
- Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis.Hepatology. 1998; 28: 695-699
- Role of hyperbilirubinemia in the impairment of osteoblast proliferation associated with cholestatic jaundice.J Clin Invest. 1995; 95: 2581-2586
- Bone metabolism and gonad function in male patients undergoing liver transplantation: a two-year longitudinal study.Osteoporos Int. 2001; 12: 749-754
- Risk factors for vertebral fractures in renal osteodystrophy.Am J Kidney Dis. 1999; 33: 287-293
- Risk factors for hip fracture among patients with end-stage renal disease.Kidney Int. 2000; 58: 2200-2205
- Increased risk of hip fracture among patients with end-stage renal disease.Kidney Int. 2000; 58: 396-399
- Approach to the patient with transplantation-related bone loss.J Clin Endocrinol Metab. 2009; 94: 1483-1490
- Differential effects of glucocorticoid on recruitment and activity of osteoclasts induced by normal and osteocalcin-deficient bone implanted in rats.Endocrinology. 1992; 131: 114-121
- Clinical review 83: mechanisms of glucocorticoid action in bone: implications to glucocorticoid-induced osteoporosis.J Clin Endocrinol Metab. 1996; 81: 3441-3447
- Post-transplantation osteoporosis.Endocrinol Metab Clin North Am. 2007; 36: 937-963
- Diagnosis and treatment of osteoporosis.Am Fam Physician. 2009; 79: 193-200
- Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation.Arch Intern Med. 2003; 163: 2165-2172
- A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system.Thromb Haemost. 2012; 108: 225-235
- Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan.Pharmacoepidemiol Drug Saf. 2011; 20: 236-242
- Rapid loss of vertebral mineral density after renal transplantation.N Engl J Med. 1991; 325: 544-550
- Severe osteoporosis before and after lung transplantation.Chest. 1996; 109: 1176-1183
- Bone loss and turnover after cardiac transplantation.J Clin Endocrinol Metab. 1997; 82: 1497-1506
- Long-term fracture risk following renal transplantation: a population-based study.Osteoporos Int. 2004; 15: 160-167
- Use of oral corticosteroids and risk of fractures.J Bone Miner Res. 2000; 15: 993-1000
- Evaluation and management of bone disease and fractures post transplant.Transplant Rev (Orlando). 2008; 22: 52-61
- Post-transplantation bone disease: the role of immunosuppressive agents and the skeleton.J Bone Miner Res. 1996; 11: 1-7
- Cyclosporin-A in vivo produces severe osteopenia in the rat: effect of dose and duration of administration.Endocrinology. 1988; 123: 2571-2577
- Effects of three immunosuppressive regimens on vertebral bone density in renal transplant recipients: a prospective study.Transplantation. 1997; 63: 380-386
- Osteoporosis before lung transplantation: association with low body mass index, but not with underlying disease.Am J Transplant. 2002; 2: 167-172
- Osteoporosis in patients undergoing lung transplantation.Eur Respir J. 1996; 9: 2378-2382
- Osteoporosis is a prevalent finding in patients with solid organ failure awaiting transplantation: a population based study.Clin Transplant. 2010; 24: E145-E152
- Incidence and long-term cost of steroid-related side effects after renal transplantation.Am J Kidney Dis. 1999; 33: 829-839
- Risk of hip fracture among dialysis and renal transplant recipients.JAMA. 2002; 288: 3014-3018
- Interventions for preventing bone disease in kidney transplant recipients: a systematic review of randomized controlled trials.Am J Kidney Dis. 2005; 45: 638-649
- Long-term bone loss in kidney transplant recipients: a cross-sectional and longitudinal study.Am J Kidney Dis. 1996; 28: 105-114
- Risk factors for fractures in kidney transplantation.Transplantation. 2002; 74: 362-366
Article Info
Publication History
Published online: May 05, 2014
Footnotes
Grant Support: This study was supported by grants from China Medical University Hospital ( DMR-102-014 and DMR-103-103 ); the Clinical Trials and Research Center for Excellence ( DOH102-TD-B-111-004 ) and the Cancer Research Center for Excellence ( MOHW103-TD-B-111-03 ), Ministry of Health and Welfare, Taiwan ; and the International Research-Intensive Centers of Excellence, Taiwan ( NSC101-2911-I-002-303 ).
Identification
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© 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
