Post-transplant Bone Mineral Disease
Kidney transplantation is
associated with mineral and bone disorders that contribute to an increased risk
of fractures and, consequently, to higher morbidity and mortality.
Post-transplant mineral and bone disorders encompass not only the persistent
effects of chronic kidney disease–mineral and bone disorder present before
transplantation, but also new pathophysiological processes driven by persistent
hyperparathyroidism, elevated fibroblast growth factor-23 levels, vitamin D
deficiency, calcium–phosphate imbalance, immunosuppressive therapies, and
changes in graft function. The assessment of bone disorder in kidney transplant
recipients includes the identification of clinical risk factors, monitoring of
biochemical parameters, evaluation of bone mineral density by dual-energy X-ray
absorptiometry, and, in selected cases, bone biopsy. However, currently
available diagnostic tools have certain limitations in precisely determining
fracture risk and characterizing the type of bone turnover. Primary management
strategies include non-pharmacological measures- such as reducing fall risk,
promoting exercise, and modifiying lifestyle- alongside adequate calcium and
vitamin D supplementation. Individualized treatment options may include
bisphosphonates, denosumab, calcimimetics, osteoanabolic agents, and
parathyroidectomy. Evidence remains limited regarding the long-term effects of
these interventions on fracture outcomes, graft safety, and their efficacy
across different patterns of bone turnover. This review aims to provide a
comprehensive overview of the current literature on the pathophysiology,
epidemiology, risk factors, diagnostic approach, and available treatment
options for mineral and bone diseases after kidney transplantation.
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