Edwards B J, Desai A, Tsai J, Du H, Edwards G R, Bunta A D, Hahr A, Abecassis M, Sprague S
Bone Health and Osteoporosis Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
J Osteoporos. 2011;2011:591793. doi: 10.4061/2011/591793. Epub 2011 Sep 12.
This study was conducted to assess the occurrence of fractures in solid-organ transplant recipients. Methods. Medical record review and surveys were performed. Patients received less than 6 months of glucocorticoids. Results. Of 351 transplant patients, 175 patients provided fracture information, with 48 (27.4%) having fractured since transplant (2-6 years). Transplants included 19 kidney/liver (50% male), 47 kidney/pancreas (53% male), 92 liver (65% male), and 17 pancreas transplants (41% male). Age at transplant was 50.8 ± 10.3 years. Fractures were equally seen across both genders and transplant types. Calcium supplementation (n = 94) and bisphosphonate therapy (n = 52) were observed, and an association with a lower risk of fractures was noted for bisphosphonate users (OR = 0.45 95% C.I. 0.24, 0.85). Fracture location included 8 (16.7%) foot, 12 (25.0%) vertebral, 3 (6.3%) hand, 2 (4.2%) humerus, 5 (10.4%) wrist, 10 (20.8%) fractures at other sites, and 7 (14.6%) multiple fractures. The estimated relative risk of fracture was nearly seventeen-times higher in male liver transplant recipients ages 45-64 years compared with the general male population, and comparable to fracture rates on conventional immunosuppressant regimens. Conclusion. We identify a high frequency of fractures in transplant recipients despite limited glucocorticoid use.
本研究旨在评估实体器官移植受者骨折的发生率。方法。进行了病历回顾和调查。患者接受糖皮质激素治疗少于6个月。结果。在351例移植患者中，175例患者提供了骨折信息，其中48例（27.4%）自移植后（2 - 6年）发生骨折。移植类型包括19例肾/肝移植（男性占50%）、47例肾/胰腺移植（男性占53%）、92例肝移植（男性占65%）和17例胰腺移植（男性占41%）。移植时年龄为50.8±10.3岁。骨折在男女两性和不同移植类型中均有出现。观察到补钙（n = 94）和双膦酸盐治疗（n = 52）情况，且双膦酸盐使用者骨折风险较低（OR = \ 0.45，95%置信区间0.24，0.85）。骨折部位包括足部8例（16.7%）、脊椎12例（25.0%）、手部3例（6.3%）、肱骨2例（4.2%）、腕部5例（10.4%）、其他部位骨折10例（20.8%）以及多发骨折7例（14.6%）。45 - 64岁男性肝移植受者骨折的估计相对风险比一般男性人群高近17倍，与传统免疫抑制方案的骨折发生率相当。结论。尽管糖皮质激素使用有限，我们仍发现移植受者骨折发生率较高。
