Kidney Week

Abstract: TH-PO1012

Optimizing Post-Transplant Bone Health in Kidney Transplant Recipients: Comparative Outcomes of Denosumab and Bisphosphonate Therapy

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Park, Woo Yeong, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Woo Yeong Park, MD, PhD

• Hwang, Jungpihl, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Jungpihl Hwang, DrMed

• Kwon, Jin Kyung, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Jin Kyung Kwon, MD

• Kim, Yaerim, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Yaerim Kim, MD, PhD

• Paek, Jin hyuk, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Jin hyuk Paek, MD, PhD

• Jin, Kyubok, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Kyubok Jin, MD, PhD

• Han, Seungyeup, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)

Seungyeup Han, MD, PhD

Background

Loss of bone mineral density (BMD) is a common and clinically significant metabolic complication after kidney transplantation, resulting from high-dose corticosteroid exposure, preexisting or persistent chronic kidney disease–mineral and bone disorder. This study compared the efficacy and safety of bisphosphonates and denosumab in kidney transplant recipients (KTRs) with osteoporosis.

Methods

We retrospectively analyzed 132 KTRs treated for osteoporosis between 2018 and 2023. KTRs were categorized based on the primary anti-osteoporotic therapy: bisphosphonate (n=31) or denosumab (n=101). Baseline demographic and biochemical parameters, including estimated glomerular filtration rate, serum calcium, phosphate, and parathyroid hormone levels, were comparable between groups. BMD at the lumbar spine and femoral neck was assessed at baseline and 12 months using dual-energy X-ray absorptiometry.

Results

After 12 months, mean lumbar spine BMD increased more in the denosumab group than in the bisphosphonate group (13.2% vs. 10.2%, p<0.001). Mean femoral neck BMD also showed a modest gain with denosumab compared with bisphosphonate therapy (4.2% vs. 4.18%, p=0.06). Hypocalcemia occurred only in the denosumab group (7.9%). Urinary tract infections were more frequent with denosumab (17.8% vs. 0%, p=0.007). However, the incidence of de novo fractures, cardiovascular events, acute kidney injury, acute rejection and graft function did not differ significantly.

Conclusion

Denosumab improved short-term BMD more effectively than bisphosphonates in KTRs, without major adverse clinical events, but requires careful monitoring for hypocalcemia and urinary tract infections in KTRs with osteoporosis.

Acknowledgment

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT, MSIT) in 2021 (2021R1F1A1061572).
This work was supported by the research promoting grant from the Keimyung University Dongsan Medical Center in 2024.

Graft survival rate between bisphosphonate and denosumab groups