Immunosuppressive therapy and bone metabolism after kidney transplantation

The success of transplant medicine due to improvements of immunosuppressive therapy has led to a significant increase of patient and organ survival. W ith the increasing number of transplantations, however, long term complicat ions, often affecting the skeletal system, are becoming more frequent. Bone alterations often exist prior to transplantation in patients with chronic renal failure. There are two types of renal osteopathy, including "low-turn over bone disease", consisting of osteomalacia, and adynamic bone disease, and "high-turnover bone disease" due to the development of secondary hyperp arathyroidism. Many patients show evidence of both disorders (mixed bone di sease). During the first months after transplantation patients lose bone ma ss rapidly. One of the major factors responsible for the development of ost eoporosis is thought to be the intensive immunosuppressive therapy during t hat period, steroids in particular seem to play an important role. To what extent other medications influence bone metabolism has not been established . Currently there are no studies about a standardized therapy and treatment relies mainly on experience with other forms of osteoporosis.