Osteoporosis is a disease that is devastating especially if someone gets a fracture from it. Being on steroids is considered a risk factor for development of osteoporosis. What are the recommendations for DEXA scan for transplant recipients? Are they different from general population and are they different if you get a steroid sparing protocol?
Dual energy X ray absorptiometry ( DEXA) is recommended in all women that are post menopausal and men with risk factors( age, smoking, so forth). Treatment is based on number of risk factors and a T score < -2.5.
When I reviewed the Nephsap on transplantation from 2006-2009, DEXA is recommended for transplant recipients on the assumption that they are now a general population. A study in AJT in 2008 linked here showed that DEXA was useful in predicting fractures in Kidney Transplant patients. The risk of fractures for those with osteoporosis and osteopenia were three and a half times and two and a half times respectively compared to normal Dexa scan patients. When to do these scans is not really defined. Should we do one scan prior to transplantation? one right after transplantation and one every 2 years is not really clarified? This needs more work in the field.
Based on the American College of Rheumatology, patients begining therapy with glucocorticoid (prednisone equivalent of 5 mg/day) with plans for treatment duration of 3 months should modify risk factors and be on vitamin d and calcium replacement but patients on long term therapy, should do the above plus receive a DEXA and if abnormal, treat and repeat annually or biannually. Should we be treating our post transplant patients similarly as the ACR recommends? Perhaps so?
The KDIQO recently put out a transplant patient treatment guidelines. Under Chapter 21: Transplant Bone disease, they suggest measurement of bone mineral density in the first 3 months after kidney transplantation if they receive steroids or have risk factors for osteoporosis as in the general population with Grade 2D evidence. They go ahead to mention that if they do have low bone density, to treat with vitamin D, Calcium and possible bisphosphanates( grade 2 evidence). But treatment decision might depend on pth, 25-oh levels and other parameters that go along with CKD. Bone biopsy might be considered but not recommended. The guidelines also mention that there is not enough data to guide treatment after first 12 months. If the transplant patient is CKD stage IV-V, DEXAs not needed to be performed as this might be different from general population.
So, the bottom line is get a DEXA at least once post transplant and treat like a general population. Follow up scans yearly might be prudent to do but there is no evidence yet.
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- Virtual Grand Rounds in Nephrology- E nephrology
- ASN's review on the ESRD bundling
- TOPIC DISCUSSION: EFFECT OF PROTEINURIA on combina...
- Poem from Pediatric Nephrologist
- TOPIC DISCUSSION: ACE induce angioedema replaced b...
- Nephsap review: Chronic Kidney Disease : CKD patie...
- Nephsap review: Chronic Kidney Disease: Troponin T...
- Bundled Payment for ESRD
- 2010 North American Dialysis and Transplantation (...
- Hematuria and Donation?
- TOPIC DISCUSSION: Do Peritoneal Dialysis patients ...
- Renal Fellow Network: Deciphering the pathologists...
- TOPIC DISCUSSION: TIDAL PD
- TOPIC DISCUSSION: DEXA SCAN in TRANSPLANT PATIENTS...
- CLINICAL CASE 21, ANSWERS AND SUMMARY
- Plagiarism In Application Essays????
- Micro RNAs and Transplantation
- IN THE NEWS: Anabolic Steroids and FSGS
- CLINICAL CASE 20, ANSWERS AND SUMMARY
- Pediatrics Grand rounds continue
- CONSULT ROUNDS: Severe Pre eclampsia
- Milk and CKD
- Transplant/Immunology Quiz 3 answers
- Rituximab and Cyclophosphamide: A Tale of Two Trea...
- CONSULT ROUNDS: HUS/TTP During Pregnancy
- IN THE NEWS: FACTOR H REPLETION in Atypical HUS
- Leflunomide and liver failure
- TOPIC DISCUSSION: Gadolinium and NSF- How to image...
- Lupus Nephritis Post Transplant
- Why do Internal Medicine Residents Choose Nephrolo...
- TOPIC DISCUSSION: TTP/HUS
- CONSULT ROUND: Hypercalcemia and Lithium
- CONSULT ROUND: ATHEROEMBOLIC DISEASE
- CONSULT ROUNDS:Rare and Interesting Cause of Hyper...
- TOPIC DISCUSSION: URR and Kt/V
- Organ Trading Discussion
- Dietary Management of Hypertension
- Chronic Dialysis: Now or Later?
- Photopheresis therapy for renal allograft rejectio...
- IN THE NEWS --->google as a diagnostician
- Live Donor Nephrectomy with vaginal extraction
- CLINICAL CASE 19, ANSWER AND SUMMARY
- IN THE NEWS- HYPOMAGNESEMIA AND PPI?
- JOB MARKET for RENAL FELLOWS
- Nephron Power: NYSN Fellows Boot camp
- NYSN Fellows Boot camp
- TOPIC DISCUSSION: captopril and stones?
- Topic Discussion: D-Lactate vs D-lactic acid
- ▼ July (48)