Men's Osteoporosis Support GroupOsteoporosis after kidney transplantation Transplant Proc. 2008 Sep;40(7):2412-3. Osteoporosis after kidney transplantation: preliminary report from a single center. Wang HH and others. PMID: 18790251. Medical organ transplantation procedures have become quite common. The post-operative therapy often involves the use of corticosteroid therapy with drugs similar to prednisone which help prevent organ rejection. Corticosteroids, however, are infamous for causing loss of bone mineral density, which can lead to osteopenia or osteoporosis, and thus increase the risk of fracture. The Wang study examined this problem and the effect on BMD of prescribing calcitonin nasal spray. In an Update on this site there are discussions of two studies involving calcitonin nasal spray (Miacalcin). Note also the cautionary note in the 11the newsletter regarding calcitonin and prostate cancer. The Wang and others study involved 67 kidney transplant patients who had dual-energy X-ray absorptiometry (DXA) bone density tests. If osteoporosis was found, they were prescribed calcitonin nasal spray. The results showed, "The incidence of osteoporosis in our kidney recipients was 46.26% (31/67 patients). Osteopenia accounted for 38.81% (26/67 patients) and only 14.93% (10/67 patients) were normal." So only 15% of patients had no loss of BMD after kidney transplant, meaning some form of osteoporosis preventive or treatment therapy is needed in 85% of kidney transplant patients. The authors also noted that, "Calcitonin inhalation seemed to improve the BMD with 61% showing improvement on the second DEXA study in our preliminary data." Editor's comments. The authors note that this was just a preliminary study and that more definitive studies are needed to confirm their results. Particularly this would be helpful to compare the results of nasal calcitonin with one of the bisphosphonates, such as alendronate (Fosamax) or risedronate (Actonel). But the important finding is that only 15% of the kidney transplant patients had no loss of BMD. Obviously it is important that physicians who provide transplant procedures, and patients who are getting transplants, are aware of the risk of osteoporosis. They must then take steps to prevent the loss of BMD, which could lead to serious fractures that would complicate the healing period after transplantation. It is not stated here, but the risk of BMD loss most likely occurs with all types of organ transplantation, particularly any transplant patients who receive high-dose corticosteroid therapy. Here is an Update on this topic for lung transplant patients showing improvement in BMD with a special lumbar exercise routine. Here is an Update with information on heart transplant patients using the same exercise method. Here is an Update with a full explanation of a similar exercise method that involves the lower back extensor muscles, and that uses much less expensive equipment than that used in the two previous studies. Note that these exercise routines, if they work, would only affect the lumbar spine BMD. Other bones, the hip, wrist, etc., could still be at increased risk for fracture, meaning one of the approved osteoporosis medications is probably needed along with the exercise to get maximum fracture prevention results after kidney (or other organ) transplantation.
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