# Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management

## TL;DR

This paper reviews the challenges of diagnosing and managing bone disease in kidney transplant recipients, which can lead to fractures and poor outcomes.

## Contribution

The paper provides a comprehensive review of the pathophysiology, diagnosis, and management of post-transplant bone disease.

## Key findings

- Post-transplant bone disease is complex and includes conditions like osteoporosis and renal osteodystrophy.
- Alternative diagnostic tools are needed due to limited availability of gold standard bone biopsy techniques.
- Both non-pharmacological and pharmacological therapies are used to manage post-transplant bone disease.

## Abstract

Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease–mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation.