Early C, Stuckey L, Tischer S
Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Victor Vaughan House, 1111 E. Catherine, Ann Arbor, MI, 48109, USA.
Osteoporos Int. 2016 Apr;27(4):1425-1440. doi: 10.1007/s00198-015-3367-8. Epub 2015 Oct 16.
The prevention and treatment of osteoporosis is an increasingly important topic in the solid organ transplant (SOT) population. Compared to the general population, these patients are at an elevated risk of developing osteoporosis due to progressive disease, lifelong immunosuppressant therapy, and malnutrition. As patients live longer after transplant, chronic disease management is increasingly more important. Supplementation with calcium and vitamin D is often necessary in the SOT population due to a high incidence of vitamin D deficiency. Bisphosphonate therapy is most commonly used for prevention and treatment of osteoporosis, but therapy can be limited by renal dysfunction which is common in transplant recipients. Alternative agents such as teriparatide and calcitonin have not been shown to provide a significant impact on the rate of fractures in this population. Additionally, denosumab may be a promising treatment option due to its novel mechanism of action, and is currently being studied in renal transplant patients. Timely initiation of supplementation and treatment, and minimizing glucocorticoid exposure prior to and after transplantation will aid in the prevention and proper management of osteoporosis in these patients.
在实体器官移植（SOT）人群中，骨质疏松症的防治是一个日益重要的话题。与普通人群相比，这些患者由于疾病进展、终身免疫抑制治疗和营养不良，发生骨质疏松症的风险更高。随着患者移植后存活时间延长，慢性病管理变得越来越重要。由于维生素D缺乏的发生率较高，SOT人群通常需要补充钙和维生素D。双膦酸盐疗法最常用于预防和治疗骨质疏松症，但该疗法可能会受到移植受者中常见的肾功能不全的限制。诸如特立帕肽和降钙素等替代药物尚未显示出对该人群骨折发生率有显著影响。此外，地诺单抗因其新颖的作用机制可能是一种有前景的治疗选择，目前正在肾移植患者中进行研究。及时开始补充和治疗，并尽量减少移植前后的糖皮质激素暴露，将有助于预防和妥善管理这些患者的骨质疏松症。
