Even after a successful kidney transplantation with good kidney function, many renal transplant patients suffer from disabling skeletal symptoms. Approximately 7-10 % of renal transplant patients may develop a fracture, mainly of the cancelleous bones, but also of the vertebrae. The fracture frequency is even higher in female renal transplant patients and much higher still in diabetic renal transplant patients. Furthermore, approximately 60% of the renal transplant patients develop a significant reduction of the bone mineral content (BMC/BMD), which is mainly manifest in the vertebrae and the hips.
The etiology of the post-transplant bone disease is multifactorial, depending upon the pre-transplant skeletal condition of the patient, upon the immunosuppressive therapy given after transplantation, upon post-transplant hormonal disturbancies and upon the GFR, which is obtained after transplantation. Bone biopsy studies have revealed alterations of bone remodelling that are reflecting a decrease in bone formation despite a continuing bone resorption. Profylaxis and treatment of the post-transplant bone disease should take into consideration the numerous patogenetic factors involved, which might vary significantly from patient to patient. As such, a “simple” and easy to manage protocol to be provided to all post-transplant patients has yet to be created.