Changes in Bone and Glucose Metabolism in Patients Post  Solid organ Transplant

Solid organ transplantation has become an increasingly common solution for treating organ failure. Organ transplantation has shown to extend patient life and decrease mortality rates. Despite the benefits of successful graft acceptance, we must assess and decrease common morbidities associated with transplantation. One major complication of these operations is metabolic changes in bone. Post-transplant patients have been shown to present with overall loss in bone mineral density as well as changes in bone microarchitecture (4). These changes ultimately lead to increased risk/rate of fracture.  Of the types of solid organ transplants performed, renal transplants are the most common, followed by liver, then heart. Kidney transplant recipients in the United States been shown to have an increased fracture risk, with 22.5% developing a fracture within 5 years (3). The time interval for fracture risk is even shorter for those receiving cardiac and liver transplants, reporting fracture frequencies of 14-27% within 2 years (1). There are many risk factors associated with metabolic bone changes. Patients with preexisting conditions such as chronic kidney or liver disease are already at risk for osteoporotic changes before transplantation even occurs (2). Other preexisting diseases that can compromise bone mineral density include diabetes mellitus and Vitamin D/Calcium disorder, conditions already prevalent in those requiring solid organ transplant. In addition, utilization of medications post-operatively for improvement of graft acceptance are known to cause osteoporotic changes. Medications such as glucocorticoids can cause decreased bone formation and increased bone resorption (6). Nonsteroidal based immunosuppressants such as Tacrolimus, a calcineurin inhibitor, have also been shown to decrease bone mineral density (5). Considering these factors, our study aims to evaluate metabolic bone changes in transplant patients, specifically renal, liver, and heart.