Low bone mass and high incidence of fractures after successful simultaneous pancreas-kidney transplantation

被引:38
作者
Smets, YFC
van der Pijl, JW
de Fijter, JW
Ringers, J
Lemkes, HHPJ
Hamdy, NAT
机构
[1] Leiden Univ Hosp, Dept Endocrinol & Metab Dis, NL-2333 AA Leiden, Netherlands
[2] Leiden Univ Hosp, Dept Nephrol & Transplantat, NL-2333 AA Leiden, Netherlands
[3] Leiden Univ Hosp, Dept Surg, NL-2333 AA Leiden, Netherlands
关键词
bone densitometry; bone metabolism; diabetes mellitus; insulin-dependent; fracture; glucocorticoids; hyperparathyroidism; kidney transplantation; pancreas transplantation;
D O I
10.1093/ndt/13.5.1250
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Simultaneous pancreas-kidney transplantation successfully restores normoglycaemia and corrects uraemia in insulin-dependent diabetes mellitus patients with end-stage renal failure due to diabetic nephropathy. Low bone turnover and cortical osteopenia are often associated with the diabetic state and cortico steroid-induced bone loss, predominantly trabecular, is expected post-transplantation. Little is known, however, about the resultant long-term effects of successful simultaneous pancreas-kidney transplantation on bone mass and consequent fracture rate. Methods. We studied bone and mineral metabolism, bone densitometry (using dual X-ray absorptiometry), and fracture prevalence in a cross-sectional design in 31 IDDM patients at least 12 months (mean 40+/-23 months) after successful simultaneous pancreas-kidney transplantation. Results. All patients were insulin-independent and mean creatinine clearance was 64+/-21 ml/min. Secondary hyperparathyroidism, probably multifactorial, was found in 55% of the patients. Increased bone turnover as suggested by elevated osteocalcin concentrations was present in 45% of the patients. Twenty-three per cent of patients bad a significant decrease in bone mass (T score < -2.5 SD) at the predominantly trabecular lumbar spine sites. In contrast, 58% demonstrated a similarly low bone mass at the femoral neck, where cortical bone is prevalent. Forty-five per cent of patients had documented vertebral (mostly asymptomatic) and non-vertebral fractures. Conclusion. Our findings suggest that low bone mass is prevalent after successful simultaneous pancreas-kidney transplantation, and that this is associated with a high incidence of fractures, representing a cause for concern with regard to long-term morbidity. Contrary to the predominant trabecular bone loss expected with corticosteroid excess, cortical bone loss was prevalent in our patients, possibly due to pre-existing diabetic state and persistent hyperparathyroidism.
引用
收藏
页码:1250 / 1255
页数:6
相关论文
共 23 条
[1]  
[Anonymous], 1992, DIABETES CARE, V15, P1668
[2]   MINERAL METABOLISM AND BONE MASS AT PERIPHERAL AND AXIAL SKELETON IN DIABETES-MELLITUS [J].
AUWERX, J ;
DEQUEKER, J ;
BOUILLON, R ;
GEUSENS, P ;
NIJS, J .
DIABETES, 1988, 37 (01) :8-12
[3]  
BOONSTRA JG, 1995, J AM SOC NEPHROL, V5, P1918
[4]   DIABETIC BONE-DISEASE [J].
BOUILLON, R .
CALCIFIED TISSUE INTERNATIONAL, 1991, 49 (03) :155-160
[5]   Long-term outcome of kidney-pancreas transplant recipients with good graft function at one year [J].
Bruce, DS ;
Newell, KA ;
Josephson, MA ;
Woodle, ES ;
Piper, JB ;
Millis, JM ;
Seaman, DS ;
Carnrike, CLM ;
Huss, E ;
Thistlethwaite, JR .
TRANSPLANTATION, 1996, 62 (04) :451-456
[6]  
BUYSSCHAERT M, 1992, DIABETES METAB, V18, P32
[7]   ANABOLIC ACTIONS OF PARATHYROID-HORMONE ON BONE [J].
DEMPSTER, DW ;
COSMAN, F ;
PARISIEN, M ;
SHEN, V ;
LINDSAY, R .
ENDOCRINE REVIEWS, 1993, 14 (06) :690-709
[8]  
Epstein S, 1996, J BONE MINER RES, V11, P1
[9]   EFFECT OF ALFACALCIDOL ON NATURAL COURSE OF RENAL BONE-DISEASE IN MILD-TO-MODERATE RENAL-FAILURE [J].
HAMDY, NAT ;
KANIS, JA ;
BENETON, MNC ;
BROWN, CB ;
JUTTMANN, JR ;
JORDANS, JGM ;
JOSSE, S ;
MEYRIER, A ;
LINS, RL ;
FAIREY, IT .
BRITISH MEDICAL JOURNAL, 1995, 310 (6976) :358-363
[10]   DIABETES-MELLITUS AND RISK OF SKELETAL FRACTURE [J].
HEATH, H ;
MELTON, LJ ;
CHU, CP .
NEW ENGLAND JOURNAL OF MEDICINE, 1980, 303 (10) :567-570