Bone Disease in Renal Transplantation and Pleotropic Effects of
Vitamin D Therapy
M.M. Sikgenc, S. Paydas, M. Balal, E. Demir, C. Kurt, Y. Sertdemir, F. Binokay, and U. Erken
ABSTRACT
Osteoporosis, osteopenia, and osteonecrosis are common in renal transplant recipients. In
this study, we evaluated relationship between bone mineral density (BMD) and posttrans-
plant duration; creatinine clearance; serum levels of glucose, calcium, phosphorus, alkaline
phosphatase, vitamin D (vitD), parathormone, magnesium, C telopeptide, osteocalcin,
lipids, and vit D therapy. Eighty five subjects included in this study had a mean age of
36.25 10.5 years. At least at 6-month intervals we measured femoral neck (FN) and
lumbar vertebra (LV) by DEXA and biochemical parameters. VitD was prescribed in 57
patients (vitDG). The mean duration of posttransplantation follow-up was 9.82 2.72
months. T scores (TS) of FN and LV were normal in 29.4% and 21.2%; osteopenia in
56.5% and 49.4%; and osteoporosis in 12.1% and 29.4% of patients, respectively. Upon
follow-up, TS improved significantly from -1.58 to -1.46 in FN and from -1.88 to -1.70
in LV (P .05 for both). In patients receiving vitDG, TS improved significantly from
-1.74 to -1.61 on FN and from -2.16 to -1.97 on LV (P .05 for both). Osteocalcin and
vitDG levels decreased in all patients (P .05 for all). Blood urea nitrogen and serum
creatinine increased (P .05). In VitDG cohort, triglyceride levels decreased (P .05)
with unchanged blood glucose values; but among the other patients, triglycerides were
unchanged but glucose levels had increased (P .05). Bone disease including osteopenia
or osteoporosis was observed among 70%. During the follow-up period, BMD increased
significantly from baseline at 9.82 2.72 months. VitD therapy caused more prominent
improvements in BMD and decreases in serum triglycerides as well as mutigated the
increase in blood glucose.
O
STEOPOROSIS, OSTEOPENIA, AND OSTEONE-
CROSIS are common complications among renal
transplant recipients. Besides the bone abnormalities of
chronic kidney disease, persistent hyperparathyroidism, im-
munosuppressive drugs such as corticosteroids
1
and cal-
cineurin inhibitors,
2
renal tubular asidosis, and renal func-
tion loss cause skelatal abnormalities after renal transplantation.
Particularly, loss of bone mineral density (BMD) is evident in
the early posttransplant period.
3
Appropriate diagnosis and
treatment of bone lesions reduces morbidity and mortality
after renal transplantation In this study, we evaluated
relationships between BMD and posttransplant duration,
creatinine clearance, serum levels of glucose, calcium,
phosphorus, alkaline phosphatase, vitamin D (vitD),
parathormone, magnesium, C-telopeptide, osteocalcin, to-
tal cholesterol, low-density lipoprotein cholesterol (LDL
C), high-density lipoprotein cholesterol (HDL C), tryglyc-
erides, and vitD therapy.
PATIENTS AND METHODS
Among 101 enrolled subjects we excluded from the study the two
who progressed to chronic renal insufficiency and 14 who discon-
tinued follow-up, leaving 85 patients including 57 males. Immuno-
suppressive treatment consisted of calcineurin inhibitors (tacroli-
mus or cyclosporine), mycophenolate mophetil (MMF), and
methylprednisolone. The drug dosages were stopulated by proto-
col. We were only changed MMF to azathioprine and calcineurin
inhibitors to mammalian target of rapamycin inhibitors (sirolimus
or everolimus) due to gastrointestinal adverse effects, hepatotoxic-
ity, thrombocytopenia, or leukopenia. Angiotensin-converting en-
zyme inhibitors or angiotensin receptor blockers were the first
From the Department of Nephrology, Cukurova University,
Medical Faculty, Adana, Turkey.
Address reprint requests to Saime Paydas, Cukurova Univer-
sity, Medical Faculty, 1330 Adana, Turkey. E-mail: spaydas@
mail.cu.edu.tr
0041-1345/10/$–see front matter © 2010 by Elsevier Inc. All rights reserved.
doi:10.1016/j.transproceed.2010.04.054 360 Park Avenue South, New York, NY 10010-1710
2518 Transplantation Proceedings, 42, 2518 –2526 (2010)