Pediatric solid organ transplantation and osteoporosis: a descriptive study on bone histomorphometric findings

• Published in: Pediatric nephrology (Berlin, West) West), 2014-08, Vol.29 (8), p.1431-1440
• Main Authors: Tamminen, Inari S., Valta, Helena, Jalanko, Hannu, Salminen, Sari, Mäyränpää, Mervi K., Isaksson, Hanna, Kröger, Heikki, Mäkitie, Outi
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Adolescent; Biopsy; Bone and Bones - pathology; Bone histomorphometry; Calcification, Physiologic; Cancellous bone; Care and treatment; Child; Children; Clinical Medicine; Complications and side effects; Cross-Sectional Studies; Female; Fracture; Fractures; Fractures, Bone - epidemiology; Glucocorticoid treatment; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Growth - physiology; Health aspects; Heart; Hospitals; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kidney transplants; Klinisk medicin; Liver; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Nephrology; Organ transplantation; Organ Transplantation - adverse effects; Original Article; Orthopedics; Ortopedi; Osteoporosis; Osteoporosis - epidemiology; Osteoporosis - etiology; Osteoporosis - pathology; Pediatrics; Puberty - physiology; Standard scores; Transplantation of organs, tissues, etc; Urology
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-014-2771-1

Background Organ transplantation may lead to secondary osteoporosis in children. This study characterized bone histomorphometric findings in pediatric solid organ transplant recipients who were assessed for suspected secondary osteoporosis. Methods Iliac crest biopsies were obtained from 19 children (7.6–18.8 years, 11 male) who had undergone kidney ( n  = 6), liver ( n  = 9), or heart ( n  = 4) transplantation a median 4.6 years (range 0.6–16.3 years) earlier. All patients had received oral glucocorticoids at the time of the biopsy. Results Of the 19 patients, 21 % had sustained peripheral fractures and 58 % vertebral compression fractures. Nine children (47 %) had a lumbar spine BMD Z-score below −2.0. Histomorphometric analyses showed low trabecular bone volume (< −1.0 SD) in 6 children (32 %) and decreased trabecular thickness in 14 children (74 %). Seven children (37 %) had high bone turnover at biopsy, and low turnover was found in 6 children (32 %), 1 of whom had adynamic bone disease. Conclusions There was a great heterogeneity in the histological findings in different transplant groups, and the results were unpredictable using non-invasive methods. The observed changes in bone quality ( i.e . abnormal turnover rate, thin trabeculae) rather than the actual loss of trabecular bone, might explain the increased fracture risk in pediatric solid organ transplant recipients.