Introduction

The development of techniques for solid organ transplantation represents a major advance in the management of patients with end-stage disease. However, in spite of the increasing survival rates achieved after transplantation, a number of serious medical complications may occur, one of which is bone disease. This chapter provides an overview of the prevalence, pathogenesis, pathophysiology and management of post-transplantation bone disease and reviews the use of biochemical markers of bone turnover in the diagnosis and monitoring of treatment of this condition.

Bone loss and fracture incidence after transplantation

Increased rates of bone loss have been documented after transplantation in many studies and certain characteristics have emerged. The rate of bone loss appears to be most rapid in the first 3–6 months and both cancellous and cortical bone are affected. Reported rates of bone loss vary considerably and have generally been higher for patients undergoing liver, lung or cardiac transplant than in those undergoing renal transplantation [1]. Even within a single transplant category, however, there are large variations in reported rates, reflecting both differences in the selection of patients and in the immunosuppressive regimens used. Some studies have demonstrated a tendency for bone mineral density (BMD) to recover after 12 months' or so posttransplantation[2], but this has not been a consistent observation. Thus, data from a recent study suggest that, in patients with renal transplants, recovery of BMD may be less prominent.