Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey.
Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey.
PLoS One. 2021 Apr 30;16(4):e0251035. doi: 10.1371/journal.pone.0251035. eCollection 2021.
Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients.
PATIENTS-METHOD: Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD.
One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024-1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015-0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX.
Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.
肾移植（KT）受者发生低骨密度（LBD）和骨折的风险增加。在这项回顾性研究中，我们调查了 KT 受者的骨矿物质密度（BMD）、椎体骨折、主要骨质疏松性骨折（MOF）和髋部骨折的发生风险。
患者-方法：纳入至少完成 KT 后一年的患者进行分析。记录人口统计学、临床和实验室数据。使用双能 X 射线吸收法进行 BMD 测量。使用常规 X 射线评估椎体骨折的半定量标准。使用 FRAX@工具结合 BMD 计算 MOF 和髋部骨折的 10 年风险。
研究纳入了 153 名 KT 受者。该人群包括 77 名女性。评估时的平均年龄为 46.5±11.9 岁。78 名（50.9%）患者的股骨颈 BMD 正常，而 12 名（7.8%）和 63 名（41.1%）患者的股骨颈存在骨质疏松症和骨量减少。评估时的年龄是 LBD 的危险因素（OR 1.057；95%CI 1.024-1.091；p=0.001）。在女性 KT 受者中，LBD 主要受绝经状态的影响，而在男性中，雷帕霉素靶蛋白（mTOR）抑制剂的使用和较低的 BMI 水平是危险因素。发现 43.4%的患者存在椎体骨折。在多变量分析中，只有类固醇的使用（OR 0.121；95%CI 0.015-0.988；p=0.049）与椎体骨折的发生相关。在所有 KT 受者中，根据 FRAX，1.9%的患者有高 MOF 概率（≥20%的骨折风险），23.5%的患者有高髋部骨折概率（≥3%的髋部骨折风险）。
探讨 LBD 和椎体骨折的患病率和危险因素有助于临床医生修改长期随访策略。此外，我们队列中髋部骨折的高风险概率表明，需要进行纵向研究以确认 FRAX 工具在移植人群中的有效性。
