This chapter summarizes the prevalence of osteoporotic fractures before transplantation, and the incidence of fractures after transplantation in patients undergoing liver, cardiac, lung, and kidney-pancreas transplantation. It also reviews information about the type of fracture, time of fracture occurrence, and risk factors for post-transplantation fracture. Risk factors for the development of bone loss and fracture can be divided into those that influence bone health before transplantation and those that affect bone loss after transplantation. Pre-transplantation risk factors include general risk factors for osteoporosis, such as age, gender, weight or body mass index, underlying endstage disease, comorbidities, and medications known to cause bone loss. The main post-transplantation factors are immunosuppressive medications, duration of immobilization after transplantation, and transplantation-related complications, such as rejection, recovery time, gonadal hormone status, and other factors. Most of the studies reviewed in this chapter reflect clinical experience where standard immunosuppressive regimens typically included glucocorticoids, cyclosporine, tacrolimus, and azathioprine. This makes it easier to draw conclusions about bone loss and fractures in patients undergoing transplantation within the past decade, but harder to assess fracture risk in patients undergoing transplantation today. Relatively few studies are available in patients treated with the newer immunosuppressive agents, such as mycophenolate mofetil or sirolimus.
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