Increased risk of fracture in patients receiving solid organ transplants

The success of organ transplantation is related to advances in immunosuppre ssive therapy, These medications are associated with medical complications including bone damage, The objective of this study was to estimate and comp are age, gender-specific fracture incidence between transplant recipients, and a large sample representative of the civilian noninstitutionalized Unit ed States population using the 1994 National Health Interview Survey (NHIS) . This was a cohort study set in tertiary care centers, Five hundred and th irty-nine individuals who received abdominal organ and 61 heart transplants surviving at least 30 days at our institution from 1986 to 1996 were inclu ded in the study, Incident fractures were ascertained by mail, in-person in terview, telephone survey, or medical record review All fractures were veri fied, Organ-, age-, and gender-specific fracture numbers and rates and pers on-years of observation, were calculated for the transplant patients, Weigh ted age- and gender-specific fracture rates from the 1994 NHLS were applied to the number of person-years of observation for each organ-specific age a nd gender category of transplant patients to generate an expected number of fractures, The ratio of observed to expected number of fractures was used to compare fracture experience of transplant patients to that of the nation al sample from the 1994 NHLS, Fifty-six of 600 (9.3%) patients had at least one fracture following 1221 person-years of observation, The sites of init ial symptomatic fracture were as follows: foot (n = 22), arm (n = 8), leg ( n = 7), ribs (n = 6), hip (n = 4), spine (n = 3), fingers (n = 3), pelvis ( n = 2), and wrist (n = 1). Fracture incidence was 13 times higher than expe cted in male heart recipients age 45-64 years; nearly 5 times higher in mal e kidney recipients age 25-44 and age 45-64 years; and 18 times and 34 time s higher in female kidney recipients age 25-44 years and 45-64 years compar ed with NHIS data, We have shown an increased incidence of fractures and es timated the magnitude of this problem in patients undergoing solid organ tr ansplantation. Our work defines the need for a long-term prospective study of fracture risk in these patients.