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Analysis of fracture prevalence in kidney-pancreas allograft recipients
Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent...
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Published in: | Journal of the American Society of Nephrology 1998-04, Vol.9 (4), p.677-683 |
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container_title | Journal of the American Society of Nephrology |
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creator | CHIU, M. Y SPRAGUE, S. M BRUCE, D. S WOODLE, E. S THISTLETHWAITE, J. R JOSEPHSON, M. A |
description | Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation. |
doi_str_mv | 10.1681/ASN.V94677 |
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Y ; SPRAGUE, S. M ; BRUCE, D. S ; WOODLE, E. S ; THISTLETHWAITE, J. R ; JOSEPHSON, M. A</creator><creatorcontrib>CHIU, M. Y ; SPRAGUE, S. M ; BRUCE, D. S ; WOODLE, E. S ; THISTLETHWAITE, J. R ; JOSEPHSON, M. A</creatorcontrib><description>Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation.</description><identifier>ISSN: 1046-6673</identifier><identifier>EISSN: 1533-3450</identifier><identifier>DOI: 10.1681/ASN.V94677</identifier><identifier>PMID: 9555671</identifier><identifier>CODEN: JASNEU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Biological and medical sciences ; Female ; Fractures, Bone - epidemiology ; Fractures, Bone - etiology ; Humans ; Immunosuppression - adverse effects ; Kidney Transplantation - adverse effects ; Male ; Medical sciences ; Middle Aged ; Pancreas Transplantation - adverse effects ; Prevalence ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Steroids - adverse effects ; Steroids - therapeutic use ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Transplantation, Homologous ; United States - epidemiology</subject><ispartof>Journal of the American Society of Nephrology, 1998-04, Vol.9 (4), p.677-683</ispartof><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-efe4b8c9d3d7f43429caad1c78dc9aa6b756c0e407a0d8936cefc6fff1f0153e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2218061$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9555671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>CHIU, M. Y</creatorcontrib><creatorcontrib>SPRAGUE, S. M</creatorcontrib><creatorcontrib>BRUCE, D. S</creatorcontrib><creatorcontrib>WOODLE, E. S</creatorcontrib><creatorcontrib>THISTLETHWAITE, J. R</creatorcontrib><creatorcontrib>JOSEPHSON, M. A</creatorcontrib><title>Analysis of fracture prevalence in kidney-pancreas allograft recipients</title><title>Journal of the American Society of Nephrology</title><addtitle>J Am Soc Nephrol</addtitle><description>Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - etiology</subject><subject>Humans</subject><subject>Immunosuppression - adverse effects</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pancreas Transplantation - adverse effects</subject><subject>Prevalence</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Steroids - adverse effects</subject><subject>Steroids - therapeutic use</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Transplantation, Homologous</subject><subject>United States - epidemiology</subject><issn>1046-6673</issn><issn>1533-3450</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><recordid>eNo9kE1LAzEQhoMotVYv3oUcPAlbk0022T2WolUoevDjukwnE1ndpkuyFfrvXWnpaQbeh2Heh7FrKabSlPJ-9vYy_ay0sfaEjWWhVKZ0IU6HXWiTGWPVObtI6VsIWeTWjtioKorCWDlmi1mAdpeaxDee-wjYbyPxLtIvtBSQeBP4T-MC7bIOAkaCxKFtN18RfM8jYdM1FPp0yc48tImuDnPCPh4f3udP2fJ18TyfLTNU2vYZedKrEiunnPVa6bxCACfRlg4rALOyhUFBWlgQrqyUQfJovPfSD78rUhN2t7-LcZNSJF93sVlD3NVS1P8y6kFGvZcxwDd7uNuu1uSO6KH9kN8eckgI7VA_YJOOWJ7LUhip_gASfmiM</recordid><startdate>19980401</startdate><enddate>19980401</enddate><creator>CHIU, M. Y</creator><creator>SPRAGUE, S. M</creator><creator>BRUCE, D. S</creator><creator>WOODLE, E. S</creator><creator>THISTLETHWAITE, J. R</creator><creator>JOSEPHSON, M. A</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>19980401</creationdate><title>Analysis of fracture prevalence in kidney-pancreas allograft recipients</title><author>CHIU, M. Y ; SPRAGUE, S. M ; BRUCE, D. S ; WOODLE, E. S ; THISTLETHWAITE, J. R ; JOSEPHSON, M. A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-efe4b8c9d3d7f43429caad1c78dc9aa6b756c0e407a0d8936cefc6fff1f0153e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - etiology</topic><topic>Humans</topic><topic>Immunosuppression - adverse effects</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pancreas Transplantation - adverse effects</topic><topic>Prevalence</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Steroids - adverse effects</topic><topic>Steroids - therapeutic use</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Transplantation, Homologous</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>CHIU, M. Y</creatorcontrib><creatorcontrib>SPRAGUE, S. M</creatorcontrib><creatorcontrib>BRUCE, D. S</creatorcontrib><creatorcontrib>WOODLE, E. S</creatorcontrib><creatorcontrib>THISTLETHWAITE, J. R</creatorcontrib><creatorcontrib>JOSEPHSON, M. A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>CHIU, M. Y</au><au>SPRAGUE, S. M</au><au>BRUCE, D. S</au><au>WOODLE, E. S</au><au>THISTLETHWAITE, J. R</au><au>JOSEPHSON, M. A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of fracture prevalence in kidney-pancreas allograft recipients</atitle><jtitle>Journal of the American Society of Nephrology</jtitle><addtitle>J Am Soc Nephrol</addtitle><date>1998-04-01</date><risdate>1998</risdate><volume>9</volume><issue>4</issue><spage>677</spage><epage>683</epage><pages>677-683</pages><issn>1046-6673</issn><eissn>1533-3450</eissn><coden>JASNEU</coden><abstract>Fractures occur in 11 to 26% of renal allograft recipients after transplantation despite improvements in bone and mineral disorders. This high fracture rate is likely a consequence of accelerated osteopenia. The cause of posttransplant bone loss is multifactorial, and patients with insulin-dependent diabetes mellitus and renal failure may have additional fracture risks such as low turnover bone disease. This retrospective cohort study was undertaken to determine the long-term incidence and the potential risk factors of posttransplant fractures in patients with insulin-dependent diabetes mellitus undergoing combined kidney-pancreas allograft transplantation. Thirty-five patients with insulin-dependent diabetes mellitus who received a combined kidney-pancreas allograft between 1987 and 1992 were evaluated. Thirty-five kidney allograft recipients matched for age, gender, and the date of transplant were also reviewed. The fracture incidence in the kidney-pancreas group was 49% after transplantation. The rate of first fracture after kidney-pancreas transplantation was 12.1% per patient year, resulting in a 5-yr fracture-free rate of 48%. The initial fracture occurred at a mean of 31.06 +/- 19.9 mo. Steroid exposure was found to increase the risk of fracture, and analysis by means of a Cox regression model estimated that an increase in cumulative steroid exposure of 10 mg/kg at any given month increased the hazard of sustaining a fracture by 9% (95% confidence interval for hazard ratio, 1.01 to 1.18; P = 0.031). This analysis suggests that kidney-pancreas recipients are at significant risk of sustaining a fracture within a few years after transplantation.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>9555671</pmid><doi>10.1681/ASN.V94677</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Biological and medical sciences Female Fractures, Bone - epidemiology Fractures, Bone - etiology Humans Immunosuppression - adverse effects Kidney Transplantation - adverse effects Male Medical sciences Middle Aged Pancreas Transplantation - adverse effects Prevalence Proportional Hazards Models Retrospective Studies Risk Factors Steroids - adverse effects Steroids - therapeutic use Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Transplantation, Homologous United States - epidemiology |
title | Analysis of fracture prevalence in kidney-pancreas allograft recipients |
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