Prevalence and causes of low bone density and fractures in kidney transplant patients
Prevalence and causes of low bone density and fractures in kidney transplant patients
复制标题
DOI：
10.1359/jbmr.2001.16.10.1863
复制
发表时间：
2001-10-01
影响因子：
6.2
通讯作者：
Barron, J
中科院分区：
文献类型：
--
作者：
Patel, S;Kwan, JTC;Barron, J
众所周知，肾移植患者会发生骨质疏松症，但有关这种并发症的患病率和原因的信息有限。我们要求我们单位所有 330 名肾移植患者参加这项研究，其中 165 名（50%）同意这样做。参与患者的特征与其余 165 名非参与者相似。 165 名参与者中，有 70 名（42%）是女性，其中 40 名是绝经后女性，而男性中只有 1 名患有性腺功能减退症。桡骨（Z 评分，-1.5）和股骨颈（Z 评分，-0.7）的骨矿物质密度（BMD）显着降低，但腰椎正常。女性所有骨骼部位的 BMD 均低于男性。 10-44% 的女性患有骨质疏松症，35-50% 的女性患有骨质减少，具体取决于部位。 BMD 与移植后的时间和累积泼尼松龙剂量成反比。 165 名患者中有 27 名（16%）在移植后出现椎骨畸形或有低位创伤性骨折史。该骨折组由 10/27 (37%) 男性和 17/27 (63%) 女性组成，其中 14 人为绝经后。与非骨折组相比，骨折患者往往年龄较大，肾衰竭、透析、移植持续时间较长，累积类固醇剂量较大，骨吸收标志物较高。环孢菌素或他克莫司的累积剂量没有发现差异。 Logistic回归显示，只有透析持续时间和移植后时间显着增加骨折风险，透析或移植每年的优势比（OR）分别为1.21（CI，1.00-1.48）和1.14（CI，1.05-1.23）。这些数据表明，低骨密度和骨折在肾移植患者中很常见，并且由移植前和移植后变量决定。女性骨折风险最大，尤其是绝经后女性，我们建议针对该亚组进行评估和治疗。
Osteoporosis is known to occur in patients with kidney transplants, but limited information is available about the prevalence and causes of this complication. We asked all 330 patients with kidney transplants in our unit to participate in this study of whom 165 (50%) agreed to do so. The characteristics of the participating patients were similar to the remaining 165 nonparticipants. Seventy of 165 (42%) of the participants were women of whom 40 were postmenopausal in contrast to the men of whom only one was hypogonadal. Bone mineral density (BMD) was significantly reduced at the radius (Z score, -1.5) and femoral neck (Z score, -0.7), but the lumbar spine was normal. BMD was lower in women than men at all skeletal sites. Osteoporosis was found in 10-44% and osteopenia was found in 35-50% of women depending on the site. BMD was related inversely to time since transplantation and cumulative prednisolone dose. Twenty-seven of the 165 (16%) patients had either vertebral deformities or a history of a low trauma fracture after transplantation. This fracture group consisted of 10/27 (37%) men and 17/27 (63%) women, of whom 14 were postmenopausal. Fracture patients tended to be older and have a longer duration of renal failure, dialysis, transplantation, greater cumulative steroid dose, and higher bone resorption markers than the nonfracture group. No differences were found for cumulative doses of cyclosporin or tacrolimus. Logistic regression showed that only duration of dialysis and time since transplantation significantly increased fracture risk, with odds ratio (OR) for each year of dialysis or transplantation being 1.21 (CI, 1.00-1.48) and 1.14 (CI, 1.05-1.23), respectively. These data show that low bone density and fractures are common in patients with kidney transplant and are determined by both pre- and posttransplant variables. Fracture risk was greatest in women, particularly if they were postmenopausal and we recommend that this subgroup is targeted for assessment and treatment.