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Long-Term Changes in Bone Mineral Density in Kidney Transplant Recipients

Naylor, Kyla L.1,2; Garg, Amit X.1,2,3; Hodsman, Anthony B.1; Rush, David N.4; Leslie, William D.4,5

doi: 10.1097/TP.0000000000000284
Clinical and Translational Research

Background Alterations in bone mineral metabolism occur when kidney function declines and often continue after transplantation. We investigated long-term changes in bone mineral density (BMD) among kidney transplant recipients undergoing routine clinical BMD monitoring and management.

Methods We identified adults receiving a kidney transplant in the province of Manitoba, Canada (1996–2011) who had greater than or equal to 2 posttransplant dual energy X-ray absorptiometry examinations. Bone mineral density was expressed as Z scores (standard deviation above/below sex-matched and age-matched reference data). The main outcome was the change in BMD.

Results A total of 326 kidney transplant recipients were included (mean age, 45 years; 61% men). Recipients were followed up for an average of 8.2 years (766 follow-up dual energy X-ray absorptiometry measurements). At baseline (first scan; median, 0.5 years after transplantation), bone density was slightly below average for age and sex (mean Z scores: lumbar spine, −0.4±1.6; femoral neck, −0.7±1.1; total hip, −0.7±1.1). At the second scan (mean, 2.7 years after first scan), mean bone density Z scores have increased (lumbar spine, −0.2±1.6; femoral neck, −0.6±1; total hip, −0.6±1.1; matched, P<0.01 at all sites). The only factor associated with a significant BMD change at all sites was osteoporosis treatment (BMD increase). Even after restricting the analysis to recipients who had not received osteoporosis treatment, final mean bone density (mean, 8.2 years after first scan) was average for age and sex (lumbar spine, +0.7±1.6; femoral neck, −0.1±1.1; total hip, 0.0±1.1).

Conclusion With routine BMD monitoring and management, posttransplant bone density typically remains stable or improves with mean values that are average for age and sex.

Supplemental digital content is available in the text.

1 Division of Nephrology, Western University, London, Ontario, Canada.

2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

3 Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.

4 Department of Medicine, University of Manitoba, Winnipeg, Ontario, Canada.

5 Address correspondence to: William Leslie, M.D., Saint Boniface General Hospital, 409 Tache Avenue, Room C5102, Winnipeg, Manitoba, Canada R2H 2A6.


William Leslie, Speaker bureau (paid to facility): Amgen, Eli Lilly, Novartis. Research grants (paid to facility): Amgen, Genzyme. Amit Garg received an investigator-initiated grant from Astellas and Roche for a Canadian Institutes of Health Research study in living kidney donors and his institution received unrestricted research funding from Pfizer.

The other authors declare no conflicts of interest.

W.L. conceived of the study and performed the statistical analysis. K.N. drafted the manuscript. All authors revised and approved the manuscript.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Received 27 March 2014. Revision requested 21 April 2014.

Accepted 5 May 2014.

Accepted July 22, 2014

© 2014 by Lippincott Williams & Wilkins