Department of Nephrology, Hospital del Mar, Autonomous University of Barcelona, Spain; Institut Mar d'Investigacions Mediques, Barcelona, Spain; REDINREN, Instituto Carlos III, Madrid, Spain.
Institut Mar d'Investigacions Mediques, Barcelona, Spain; Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Spain; CIBERFES, Instituto Carlos III, Madrid, Spain.
Bone. 2018 Nov;116:290-294. doi: 10.1016/j.bone.2018.08.013. Epub 2018 Aug 23.
Soon after kidney transplant (KT), a decrease in parathormone and bone mineral density (BMD) occur, but little is known on the impact of KT on novel bone quality parameters including trabecular bone score (TBS) and bone material strength index (BMSi). We aimed to study BMD, TBS and BMSi in the first year after KT, in patients not treated with any bone therapy. A cohort including 36 patients underwent KT on a low-glucocorticoid-dose protocol (5 mg daily-prednisone from post-operative-day 42 onwards) and was observed for 12 months prospectively. At 3 months, phosphorus and parathormone decreased, while calcium increased. We also observed at 3 months a transient mild 2.9% bone loss at femoral neck (BMD change 0.752 ± 0.15 vs 0.730 ± 0.15; p = 0.004), but no change at either spine or total hip. Both TBS and BMSi remained stable. At 12 months, lumbar (but not total hip or femoral neck) BMD slightly decreased by 2.1% vs baseline (0.950 ± 0.15 vs 0.930 ± 0.5; p = 0.046), while TBS and BMSi remained unmodified. In KT patients on low-dose glucocorticoids and no bone therapy, there were small BMD decreases at femoral neck (at 3 months) and lumbar spine (at 12 months), but no change in either TBS or BMSi. Low-dose post-KT glucocorticoid treatment shows limited impact on bone, supporting steroid-restrictive protocols.
肾移植（KT）后不久，甲状旁腺激素和骨密度（BMD）会下降，但对于 KT 对包括骨小梁评分（TBS）和骨材料强度指数（BMSi）在内的新型骨质量参数的影响知之甚少。我们旨在研究未接受任何骨治疗的患者在 KT 后 1 年内的 BMD、TBS 和 BMSi。一个包括 36 名患者的队列接受了低剂量糖皮质激素方案的 KT（术后第 42 天开始每天 5mg 泼尼松），并前瞻性观察了 12 个月。3 个月时，磷和甲状旁腺激素下降，而钙增加。我们还观察到 3 个月时股骨颈的短暂轻度 2.9%骨丢失（BMD 变化 0.752±0.15 与 0.730±0.15；p=0.004），但脊柱或全髋关节无变化。TBS 和 BMSi 保持稳定。12 个月时，腰椎（而非全髋关节或股骨颈）BMD 与基线相比略有下降 2.1%（0.950±0.15 与 0.930±0.5；p=0.046），而 TBS 和 BMSi 保持不变。在接受低剂量糖皮质激素和无骨治疗的 KT 患者中，股骨颈（3 个月时）和腰椎（12 个月时）的 BMD 略有下降，但 TBS 和 BMSi 没有变化。KT 后低剂量糖皮质激素治疗对骨骼的影响有限，支持限制类固醇的方案。
