Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2000 Aug;83(2):146–151. doi: 10.1136/adc.83.2.146

Bone metabolism and mineral density following renal transplantation

G Reusz 1, A Szabo 1, F Peter 1, E Kenesei 1, P Sallay 1, K Latta 1, A Szabo 1, A Szabo 1, T Tulassay 1
PMCID: PMC1718413  PMID: 10906024

Abstract

AIM—To study bone turnover following renal transplantation using a panel of biochemical markers and to correlate the results with both areal and volumetric bone mineral density (BMD).
PATIENTS—A total of 31 patients aged 18.1 years were transplanted 5.4 years before this study. Control patients (n = 31) were age and gender matched.
METHODS—In addition to measurement of biochemical markers, BMD was measured by single photon absorptiometry and peripheral quantitative computed tomography on the non-dominant radius.
RESULTS—Patients had reduced glomerular filtration rate, raised concentrations of serum phosphate, serum procollagene type I carboxy terminal propeptide, osteocalcin, and serum procollagene type I cross linked carboxy terminal telopeptide. The differences were still significant if only patients with normal intact parathyroid hormone were considered. BMD single photon absorptiometry Z score for age was significantly decreased. Following standardisation for height the differences were no longer present. With volumetric techniques patients had normal trabecular but decreased cortical and total BMD compared to age matched controls, but there was no difference from height matched controls.
CONCLUSION—Markers of bone turnover are increased following renal transplantation. However, the biochemical analysis did not allow conclusions to be drawn on the bone mineral content. BMD single photon absorptiometry Z score corrected for height and BMD measured by quantitative computed tomography compared to height matched controls were normal in paediatric renal transplantation patients. Height matched controls should be used in both areal and volumetric BMD measurements in states of growth failure.



Full Text

The Full Text of this article is available as a PDF (115.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boot A. M., Nauta J., Hokken-Koelega A. C., Pols H. A., de Ridder M. A., de Muinck Keizer-Schrama S. M. Renal transplantation and osteoporosis. Arch Dis Child. 1995 Jun;72(6):502–506. doi: 10.1136/adc.72.6.502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Branca F., Robins S. P., Ferro-Luzzi A., Golden M. H. Bone turnover in malnourished children. Lancet. 1992 Dec 19;340(8834-8835):1493–1496. doi: 10.1016/0140-6736(92)92754-4. [DOI] [PubMed] [Google Scholar]
  3. Chesney R. W., Rose P. G., Mazess R. B. Persistence of diminished bone mineral content following renal transplantation in childhood. Pediatrics. 1984 Apr;73(4):459–466. [PubMed] [Google Scholar]
  4. Cueto-Manzano A. M., Konel S., Hutchison A. J., Crowley V., France M. W., Freemont A. J., Adams J. E., Mawer B., Gokal R. Bone loss in long-term renal transplantation: histopathology and densitometry analysis. Kidney Int. 1999 May;55(5):2021–2029. doi: 10.1046/j.1523-1755.1999.00445.x. [DOI] [PubMed] [Google Scholar]
  5. Feber J., Cochat P., Braillon P., Castelo F., Martin X., Glastre C., Chapuis F., David L., Meunier P. J. Bone mineral density after renal transplantation in children. J Pediatr. 1994 Dec;125(6 Pt 1):870–875. doi: 10.1016/s0022-3476(05)82001-3. [DOI] [PubMed] [Google Scholar]
  6. Florén C. H., Ahrén B., Bengtsson M., Bartosik J., Obrant K. Bone mineral density in patients with Crohn's disease during long-term treatment with azathioprine. J Intern Med. 1998 Feb;243(2):123–126. doi: 10.1046/j.1365-2796.1998.00246.x. [DOI] [PubMed] [Google Scholar]
  7. Hamdy N. A., Risteli J., Risteli L., Harris S., Beneton M. N., Brown C. B., Kanis J. A. Serum type I procollagen peptide: a non-invasive index of bone formation in patients on haemodialysis? Nephrol Dial Transplant. 1994;9(5):511–516. doi: 10.1093/ndt/9.5.511. [DOI] [PubMed] [Google Scholar]
  8. Klaus G., Paschen C., Wüster C., Kovacs G. T., Barden J., Mehls O., Schärer K. Weight-/height-related bone mineral density is not reduced after renal transplantation. Pediatr Nephrol. 1998 Jun;12(5):343–348. doi: 10.1007/s004670050464. [DOI] [PubMed] [Google Scholar]
  9. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990 Mar 1;112(5):352–364. doi: 10.7326/0003-4819-112-5-352. [DOI] [PubMed] [Google Scholar]
  10. Mazzaferro S., Pasquali M., Ballanti P., Bonucci E., Costantini S., Chicca S., De Meo S., Perruzza I., Sardella D., Taggi F. Diagnostic value of serum peptides of collagen synthesis and degradation in dialysis renal osteodystrophy. Nephrol Dial Transplant. 1995;10(1):52–58. [PubMed] [Google Scholar]
  12. Parfitt A. M., Drezner M. K., Glorieux F. H., Kanis J. A., Malluche H., Meunier P. J., Ott S. M., Recker R. R. Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR Histomorphometry Nomenclature Committee. J Bone Miner Res. 1987 Dec;2(6):595–610. doi: 10.1002/jbmr.5650020617. [DOI] [PubMed] [Google Scholar]
  13. Prader A., Largo R. H., Molinari L., Issler C. Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl. 1989 Jun;52:1–125. [PubMed] [Google Scholar]
  14. Reusz G. S., Dobos M., Vásárhelyi B., Sallay P., Szabó A., Horváth C., Szabó A., Byrd D. J., Thole H. H., Tulassay T. Sodium transport and bone mineral density in hypercalciuria with thiazide treatment. Pediatr Nephrol. 1998 Jan;12(1):30–34. doi: 10.1007/s004670050398. [DOI] [PubMed] [Google Scholar]
  15. Reusz G. S., Miltényi G., Stubnya G., Szabó A., Horváth C., Byrd D. J., Péter F., Tulassay T. X-linked hypophosphatemia: effects of treatment with recombinant human growth hormone. Pediatr Nephrol. 1997 Oct;11(5):573–577. doi: 10.1007/s004670050340. [DOI] [PubMed] [Google Scholar]
  16. Salusky I. B., Ramirez J. A., Oppenheim W., Gales B., Segre G. V., Goodman W. G. Biochemical markers of renal osteodystrophy in pediatric patients undergoing CAPD/CCPD. Kidney Int. 1994 Jan;45(1):253–258. doi: 10.1038/ki.1994.31. [DOI] [PubMed] [Google Scholar]
  17. Sanchez C. P., Salusky I. B., Kuizon B. D., Ramirez J. A., Gales B., Ettenger R. B., Goodman W. G. Bone disease in children and adolescents undergoing successful renal transplantation. Kidney Int. 1998 May;53(5):1358–1364. doi: 10.1046/j.1523-1755.1998.00866.x. [DOI] [PubMed] [Google Scholar]
  18. Schönau E. Problems of bone analysis in childhood and adolescence. Pediatr Nephrol. 1998 Jun;12(5):420–429. doi: 10.1007/s004670050479. [DOI] [PubMed] [Google Scholar]
  19. Schönau E. The development of the skeletal system in children and the influence of muscular strength. Horm Res. 1998;49(1):27–31. doi: 10.1159/000023122. [DOI] [PubMed] [Google Scholar]
  20. Schönaü E., Wentzlik U., Michalk D., Scheidhauer K., Klein K. Is there an increase of bone density in children? Lancet. 1993 Sep 11;342(8872):689–690. doi: 10.1016/0140-6736(93)91805-v. [DOI] [PubMed] [Google Scholar]
  21. Spindler A., Paz S., Berman A., Lucero E., Contino N., Peñalba A., Tirado S., Santana M., Zeballos A. C. Muscular strength and bone mineral density in haemodialysis patients. Nephrol Dial Transplant. 1997 Jan;12(1):128–132. doi: 10.1093/ndt/12.1.128. [DOI] [PubMed] [Google Scholar]
  22. Szabo A., Heemann U. Ischemia reperfusion injury and chronic allograft rejection. Transplant Proc. 1998 Dec;30(8):4281–4284. doi: 10.1016/s0041-1345(98)01414-6. [DOI] [PubMed] [Google Scholar]
  23. Trotter M., Hixon B. B. Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec. 1974 May;179(1):1–18. doi: 10.1002/ar.1091790102. [DOI] [PubMed] [Google Scholar]
  24. Ureña P., De Vernejoul M. C. Circulating biochemical markers of bone remodeling in uremic patients. Kidney Int. 1999 Jun;55(6):2141–2156. doi: 10.1046/j.1523-1755.1999.00461.x. [DOI] [PubMed] [Google Scholar]
  25. del Pozo E., Lippuner K., Ruch W., Casez J. P., Payne T., MacKenzie A., Jaeger P. Different effects of cyclosporin A on bone remodeling in young and adult rats. Bone. 1995 Apr;16(4 Suppl):271S–275S. doi: 10.1016/8756-3282(95)00024-8. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES