The Bone in Renal Transplant Recipients-A Nephrological and Orthopedic Review

Abstract

The definition of Chronic Kidney Disease Mineral Bone Disorder (CKD-MBD) has suffered significant changes over the last decade as our knowledge on the matter grows. The complexity of this subject is even bigger if you consider renal transplant recipients (RTRs) they already have a legacy of CKD-MBD previous to transplant, their bones will be under the direct and indirect effects of immunosuppression and they will develop CKD-MBD secondary to their graft (dis) function. All these issues occur in addition to the risk factors of the general population for bone disease. Diagnosis and management of CKD-MBD in RTRs is difficult, several tools are yet to be validated and bone biopsy is not widely available. In the past years, new therapeutic strategies have been proposed for these patients. Special consideration should be given to the orthopedic management in RTRs regarding fracture risk and avascular necrosis of the major joints, particularly the femoral head, due to the effects of immunosuppression.