1. Published guidelines for bone disease in kidney transplant recipients.

Guideline	Country	Year	Recommendation
Kidney Disease: Improving Global Outcomes (KDIGO) 2009 Clinical Practice Guideline for CKD Mineral and Bone Disorder (CKD‐MBD) (KDIGO CKD‐MBD Guideline 2009)	International	2009	Serum concentrations of calcium, phosphorous and intact PTH should be monitored following transplantation. Serial 25(OH) vitamin D measurements should be considered. The lowest effective dose of glucocorticoids should be used. Recommend vitamin D deficiency and insufficiency be corrected. BMD measurement by DEXA scan is suggested within the first 3 months of transplantation if eGFR > 30 mL/min/1.73 m2 and patient is on corticosteroids or have risk factors for osteoporosis. In the first 12 months post transplantation, if eGFR > 30 mL/min/1.73 m2 and low BMD, suggest vitamin D, calcitriol/alpha calcidiol, or bisphosphonate be considered. Insufficient data to guide treatment after the first 12 months. Suggest BMD testing not performed routinely as BMD does not predict fracture risk or the type of transplant bone disease.
Kidney Disease: Improving Global Outcomes (KDIGO) 2009 Clinical Practice Guideline for the Care of Kidney Transplant (KDIGO Transplant Guideline 2009)	International	2009	See Kidney Disease: Improving Global Outcomes (KDIGO) 2009 Clinical Practice Guidelines for CKD Mineral and Bone Disorder (CKD‐MBD) (KDIGO CKD‐MBD Guideline 2009)
Kidney Disease Outcome Quality Initiative (K‐DOQI) (KDOQI 2010)	United States of America	2010	Commentary on 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD‐Mineral and Bone Disorder (CKD‐MBD) Serum concentrations of calcium, phosphorous and intact PTH should be monitored following transplantation. Serial 25(OH) vitamin D measurements should be considered. The lowest effective dose of glucocorticoids should be used. Recommend vitamin D deficiency and insufficiency be corrected. BMD measurement by DEXA scan is restricted to high risk populations including those receiving significant doses of corticosteroids or those with risk factors for osteoporosis in the general population. Bone density screening is suggested only for individuals with a well‐functioning transplant. Patients with more advanced CKD will more likely have abnormal bone quality from CKD mineral and bone disorder which is likely to compromise the ability of BMD to predict fracture. In the first 12 months post transplantation, if eGFR > 30 mL/min/1.73 m2 and low BMD, suggest vitamin D, calcitriol/alpha calcidiol, or bisphosphonate be considered, although due to the relative lack of evidence, treatment is discretionary. Insufficient data to guide treatment after the first 12 months. There is insufficient evidence to support treatment recommendations for bone disease in children. It is reasonable to consider bone biopsy to guide treatment, particularly before using bisphosphonate because these agents have better efficacy in high bone turnover and may lead to adynamic bone disease.
Caring for Australians with Renal Impairment (CARI) (Chadban 2009)	Australia and New Zealand	2009	Kidney transplant recipients should be advised to take a vitamin D (or analogue) supplement at a low dose of at least 0.25 µg daily. Commentary on 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients No specific comment on 2009 KDIGO guidelines for care of kidney transplant recipients.
Canadian Society of Nephrology (CSN) (Knoll 2010)	Canada	2010	Commentary on 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant recipients No evidence for benefit resulting from supplementation to "sufficient" levels of serum 25 hydroxyvitamin D (> 75 nmol/L) and the clinical harm has not been defined. Bone biopsy is rarely available. In patients who have no biochemical evidence of CKD bone and mineral disorder, it is reasonable to assess and treat patients for their future fracture risk according to guidelines for the general population. management would include routine supplementation with vitamin D (800 to 2,000 U daily) and calcium (1000 to 15,000 mg daily) with specific pharmacotherapy based on overall risks of fracture, including bisphosphonate therapy when appropriate. Bone density should not be measured routinely to form the basis of diagnostic and therapeutic decisions.
European Best Practice Guidelines (EPBG) (ERBP 2011)	Europe	2011	Endorsement of the 2009 KDIGO Clinical Practice Guideline for Care of Kidney Transplant Recipients Endorsement of the 2009 KDIGO guidelines for care of kidney transplant recipients (KDIGO CKD‐MBD Guideline 2009) (no specific commentary on bone disease management).
British Renal Association (Baker 2010)	United Kingdom	2010, 2011	Post‐operative care of the kidney transplant recipient: bone and joint disease (Baker 2017) Recipients of kidney transplantation with osteoporosis or high risk should be considered for steroid‐avoiding immunosuppression. Recipients of a kidney transplant should undergo bone density measurement if eGFR > 30 mL/min/1.73 m2. Treatment should be according to the Royal College of Physicians guidelines for steroid induced osteoporosis. Commentary on 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant recipients The recommendations on transplant bone disease are derived from the KDIGO guideline on the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease‐Mineral and Bone Disorder (CKD‐MBD). The widespread use of DEXA scanning is not recommended since it predicts neither the occurrence of fractures nor the type of bone disease.