POSTTRANSPLANTATION METABOLIC BONE-DISEAS E

Following renal transplantation there is often an incomplete resolutio n of both renal osteodystrophy and secondary hyperparathyroidism. In a ddition, posttransplantation hone disease and other transplantation-re lated disturbances of the skeleton may occur. Since there is a high ra te of slow, but spontaneous, resolution of posttransplant hypercalcemi a, hyperparathyroidism may be managed with a conservative approach for at least 12 months. Progressive osteitis fibrosa itself does not nece ssarily imply a surgical approach, since hyperparathyroid bone disease can be treated with bisphosphonates parenterally as long as graft fun ction is reasonably good. However, subtotal parathyroidectomy is indic ated in patients presenting with severe or symptomatic hypercalcemia, nephrocalcinosis, nephrolithiasis, or soft tissue calcifications. Post -transplantation bone loss is especially apparent at cancellous sires, whereas cortical bone is little affected. Prevention and management o f post-transplantation osteoporosis has to consider the degree of oste openia, the dosage of glucocorticoids, as well as graft function. Avas cular necrosis commonly involves the femoral head. but other sites suc h as the knee, the humoral head, or the talus may be affected as well. These lesions have to be distinguished from transient osteoporosis, f rom the syndrom of osteoarticular pain of lower limbs, and from other causes of arthritis such as gout, pseudo-gout, cytomegalovirus, or sep tic arthritis.