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Abstract: FR-OR06

Early Changes in Bone Turnover Markers Predict Bone Loss After Kidney Transplantation

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Joergensen, Hanne Skou, Katholieke Universiteit Leuven, Leuven, Belgium
  • D'Haese, Patrick, Universiteit Antwerpen, Antwerpen, Belgium
  • Cavalier, Etienne, Universite de Liege, Liege, Belgium
  • Evenepoel, Pieter, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
Background

Bone mineral density (BMD) changes are highly variable after kidney transplantation (TX) with subgroups of patients gaining or losing BMD in the first post-TX year. We investigated whether early changes in bone turnover markers (BTMs) could predict the BMD trajectory, which could enable targeted therapy.

Methods

BMD was measured at TX and 1 yr and parathyroid hormone (PTH) and BTMs at TX, 3 mo, and 1 yr (n=230). Paired transiliac bone biopsies were available in a subset (n=49).

Results

Lumbar spine BMD loss at 1 yr was associated with higher PTH and BTMs at TX, with greater decreases in BTMs at 3 and 12 mo (Table). Trajectories of BTMs differed for patients gaining and losing BMD (Figure). By bone biopsy, patients with lumbar spine BMD gain vs loss had greater decreases in osteoid volume (-1.7 vs +2.2%, p=0.01) and surface (-9.09 vs +8.97uM, p=0.01). Changes in cortical porosity and thickness by micro-CT (n=19) were minimal and unrelated to changes in BMD.

Conclusion

Rapid mineralization of osteoid results in substantial BMD gain post-TX in a subset of patients. Changes in bone turnover markers during the first 3 mo can be used to predict the trajectory of BMD in the first post-TX yr.

Table
BiochemistryLumbar spine BMD loss (<-2.5%) (n=78)Lumbar spine BMD neutral (n=86)Lumbar spine BMD gain (>2.5%) (n=66)P
Biointact parathyroid hormone (TX), xUNL2.78 (1.40; 4.49)3.22 (2.01; 5.71)4.83 (2.73; 8.69)<0.001
Bone-specific alkaline phosphatase (TX), ug/L17.4 (13.6; 23.8)18.8 (14.8; 29.3)30.8 (21.5; 49.5)<0.001
Tartrate resistant acid phospahtase isoform 5b (TX), U/L4.73 (3.17; 6.58)5.03 (3.73; 7.25)5.99 (3.94; 9.08)0.01
Estimated glomerular filtration rate (12mo), mL/min/1.73m2 48.02 (36.37; 57.56)46.00 (38.07; 54.90)51.58 (43.91; 60.14)0.03
Biointact parathyroid hormone (12mo), xUNL1.17 (0.69; 2.11)0.97 (0.64; 1.94)1.01 (0.68; 1.79)0.43
Bone-specific alkaline phosphatase (12mo), ug/L20.6 (13.7; 29.2)15.6 (11.3; 23.7)13.8 (10.4; 21.2)0.001
Tartrate resistant acid phospahtase isoform 5b (12mo), U/L3.89 (2.93; 5.20)3.06 (2.15; 4.14)2.71 (1.78; 4.12)<0.001
ΔBALP (3mo), %-7.8 (-32.3; 35.6)-23.4 (-47.6; 3.8)-34.1 (-61.7; -1.7)<0.001
ΔTRAP5b (3mo), %-26.8 (-48.2; 0.3)-44.5 (-58.6; -20.3)-52.2 (-67.3; -32.4)<0.001
ΔBALP (12mo), %-1.1 (-25.8; 67.5)-22.7 (-48.1; 18.8)-51.5 (-70.8; -30.6)<0.001
ΔTRAP5b (12mo), %-13.1 (-41.6; 13.5)-38.7 (-57.0; -17.1)-54.9 (-67.6; -42.7)<0.001

Median(IQR) with P by Kruskal-Wallis test