Lee Eun Song, Lim Jeong-Hoon, Cho Jang-Hee, Jung Hee-Yeon, Choi Ji-Young, Park Sun-Hee, Kim Yong-Lim, Ro Han, Lee Sik, Han Seung-Yeup, Jung Cheol Woong, Park Jae Berm, Kim Myoung Soo, Yang Jaeseok, Ahn Curie, Kim Chan-Duck
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, South Korea.
Transplant Proc. 2019 Oct;51(8):2704-2709. doi: 10.1016/j.transproceed.2019.03.071. Epub 2019 Aug 30.
There is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT.
A total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures.
Twenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT.
Pretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.
肾移植（KT）后骨折风险较高。KT受者易患持续性甲状旁腺功能亢进及其他骨与矿物质代谢紊乱疾病。然而，KT后骨折的危险因素仍不明确。本研究旨在调查KT后骨折的危险因素。
2012年至2016年，从韩国一项多中心观察性队列研究中纳入了941例KT受者。在KT时测量生化指标，然后在KT后的5年中每年测量一次。记录所有骨折事件。进行Cox比例风险分析以计算危险因素与骨折关联的风险比（HR）。
在研究期间，20例患者发生了22次骨折。骨折患者组与非骨折患者组之间矿物质和骨生化指标的基线及系列变化相似。在整个研究人群中，104例患者在移植前骨密度测试中被诊断为骨质疏松症，422例患者被诊断为骨量减少。在多变量Cox分析中，移植前骨质疏松症（HR = 11.76；95%置信区间[CI]，2.28 - 60.69；P = 0.003）和移植前骨量减少（HR = 5.21；95% CI，1.15 - 23.57；P = 0.032）是KT受者骨折的独立危险因素。
移植前骨质疏松症和骨量减少是KT后骨折的独立危险因素。在KT前后更仔细地监测骨密度可能有助于预测KT后骨折的风险。
