Approach to the treatment of posttransplant osteoporosis in kidney transplant recipients

This algorithm summarizes our suggested approach to the management of osteoporosis diagnosed at least 12 months after kidney transplantation. Osteoporosis may be diagnosed based on bone mineral density measurement (T-score ≤–2.5 at any site) or occurrence of nontraumatic (fragility) fracture(s). This algorithm is intended for use with other UpToDate content on the prevention and treatment of osteoporosis after kidney transplantation.

BSAP: bone-specific alkaline phosphatase; CTX: C-telopeptide; eGFR: estimated glomerular filtration rate.

* Posttransplant osteoporosis is defined as osteoporosis (T-score ≤–2.5 at hip, spine, or forearm or history of fragility fracture) that is diagnosed at least 12 months after transplantation.

¶ Lifestyle measures include weight-bearing exercise, smoking cessation, good nutrition, limiting alcohol intake, early mobilization after transplantation, and fall prevention.

Δ Refer to UpToDate content on the treatment of persistent hyperparathyroidism after kidney transplantation.

◊ Biochemical evidence of low bone turnover is defined as CTX and BSAP concentrations in the lower one-third of the assay-specific reference range for premenopausal females. Biochemical evidence of high bone turnover is defined as CTX and BSAP concentrations in the upper two-thirds of the assay-specific reference range for premenopausal females.

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Approach to the treatment of posttransplant osteoporosis in kidney transplant recipients