BONE-FRACTURE AND OSTEODENSITOMETRY WITH DUAL-ENERGY X-RAY ABSORPTIOMETRY IN KIDNEY-TRANSPLANT RECIPIENTS

Kidney transplant recipients have multiple factors leading to osteopor osis. The purpose of this study was to determine the fracture rate aft er kidney transplantation and the significance of osteodensitometry wi th dual energy x-ray absorptiometry (DXA) in identifying the risk pati ents. Bone mineral density (BMD) was measured with DXA in 100 graft re cipients (mean interval 63+/-53 months after transplantation) and corr elated with the incidence of fractures. Fracture rate of peripheral bo nes increased from 0.009 before transplantation and 0.012 on hemodialy sis to 0.032 fractures per patient and year after transplantation. Sev enteen fractures of peripheral bones occurred in 11% of the patients w ithin a mean of 103+/-59 months after transplantation. Three additiona l patients had fractures of the lumbar spine. Patients with fractures were characterized by low or low-normal BMD (0.93+/-0.23 versus 1.04+/ -0.17 g/cm(2) at lumbar spine), a frequent history of parathyroidectom y (21% versus 6%), and a longer transplant interval (103+/-59 versus 5 7+/-49 months). Fractures occurred in patients with low and normal BMD . DXA at the femoral neck proved to be of no value to define patients at risk of fractures. DXA at the lumbar spine also proved to be of lim ited value for this question. Therefore, alternatively, more sensitive methods of BMD and of bone architecture measurements are necessary fo r identifying the kidney transplant recipients at risk of fracture.