The use of bisphosphonates in renal transplant

recipients is yet to be supported by large randomized controlled trials. In the non-transplant population concerns exist regarding the association between atypical fractures and bisphosphonates caused by reduced bone remodelling. Nevertheless, the absolute risk of atypical fractures with bisphosphonate use may be small compared with the beneficial effects of the drug.1 A randomized, prospective, controlled trial in 72 new renal transplant patients was performed with prophylactic pamidronate at months 0, 1, 2, 3 and 6.2 A subgroup of patients had bone biopsies. Pamidronate preserved vertebral, but not hip BMD during treatment and for 6 months after cessation. Fifty per cent of all patients had low bone turnover disease at baseline Autophagy Compound Library and all pamidronate-treated patients had adynamic bone disease at 6 months. The study was not powered to examine fracture rates and did not determine whether improved BMD with adynamic bone disease is ultimately beneficial or harmful. Dual energy X-ray absorptiometry of the hip region has been shown to predict fractures in renal transplant Alectinib purchase recipients in 238 patients investigated between 1995 and 2007 in a single-centre study.3 Bisphosphonates had been prescribed

in 12.8% and 13% had undergone parathyroidectomy. Osteoporosis was present in 13.9% and osteopaenia in 46% of hips studied. Forty-six of the 238 patients suffered any fracture after DEXA. Osteopaenia and osteoporosis were independent risk factors for fracture,

with a relative risk of 2.7 and 3.5 respectively. Hip BMD was found to be a better predictor of future fractures compared with lumbar BMD possibly because of aortic calcification or undiagnosed lumbar spine fractures. Hyperparathyroidism post-kidney transplantation may be caused by secondary hyperparathyroidism and hyperplastic parathyroid glands or tertiary hyperparathyroidism with autonomous functioning of monoclonal parathyroid cells. Common practice is to delay parathyroidectomy for at least 6 months from the time of transplantation Edoxaban as involution of the parathyroid glands may obviate the need for surgery. Kidney Disease: Improving Global Outcomes (KDIGO) has no specific guidelines advising on post-transplantation parathyroidectomy.4 A single-centre retrospective analysis between 1983 and 1995 examined 37 kidney transplant patients who underwent parathyroidectomy and were followed for up to 13 years.5 Parathyroidectomy was performed after an average of 36.7 months post-transplantation. Of this cohort, 13 patients experienced rejection and became dialysis-dependent, 24 had persistent good renal function, 7 died and 4 developed hypoparathyroidism. Fifty-six per cent of patients still required parathyroidectomy after more than 1 year post-transplantation and the authors therefore advocated early surgery after transplantation.