Bone complications of heart transplantation

Factors that contribute to bone disease in patients with heart or lung disease

Bone loss after heart transplantation

Graph of bone loss in liver transplant patients Each line on the graph is data from a different study.

Fractures in liver transplant recipients

Graph of fractures in liver transplant patients The grey background shows number of patients in each study, the black bars are the fracture rates. Bone density is generally lower in patients who get a fracture, but some patients fracture despite normal bone density. Older patients and women are more likely to fracture.

The osteocalcin levels decrease during the first 3 months after transplantation, and then they increase to levels higher than normal. The collagen-cross-links also increase.

A recent study has shown that magnesium intake was inversely associated with bone loss in heart transplant recipients. This is possibly related to PTH, which may be lower in the patients who took less magnesium.

Several small or uncontrolled studies have been done in patients after heart transplantation, but the results are not consistent. Agents used have included calcitonin, calcidiol, calcitriol, etidronate, pamidronate, or alendronate.

Hypercalcemia has been reported after vitamin D treatment, The bisphosphonates decreased bone loss in some studies but not in others. No obvious side effects or interactions with cyclosporine were described in these studies during the first year of treatment.

Table of literature review


Aris, R. M.(1996). Severe osteoporosis before and after lung transplantation. Chest 109(5): 1176-83.

Berguer, D. G.(1994). Osteoporosis in heart transplant recipients: a longitudinal study. Transplant Proc 26(5): 2649-51.

Boncimino, K.(1999). Magnesium deficiency and bone loss after cardiac transplantation. Journal of Bone and Mineral Research 14(2): 295-303.

Dopff, C.(1998). Consequences of heart transplantation on calcium metabolism. Transplant Proc 30(6): 2833-4.

Garcia-Delgado, I.(1997). Calcitonin, etidronate, and calcidiol treatment in bone loss after cardiac transplantation. Calcif Tissue Int 60(2): 155-9.

Garlicki, A. M.(1996). Measurement of radial bone mineral density in patients after heart transplantation. Ann Transplant 1(4): 32-4.

Glendenning, P.(1999). High prevalence of osteoporosis in cardiac transplant recipients and discordance between biochemical turnover markers and bone histomorphometry. Clinical Endocrinology 50(3): 347-355.

Guo, C. Y.(1998). Mechanisms of bone loss after cardiac transplantation. Bone 22(3): 267-71.

Henderson, N. K.(1995). Bone mineral loss and recovery after cardiac transplantation [letter]. Lancet 346(8979): 905.

Lee, A. H.(1994). Osteoporosis and bone morbidity in cardiac transplant recipients. Am J Med 96(1): 35-41.

Muchmore, J. S.(1991). Loss of vertebral bone density in heart transplant patients. Transplant Proc 23(1 Pt 2): 1184-5.

Muchmore, J. S.(1992). Prevention of loss of vertebral bone density in heart transplant patients. J Heart Lung Transplant 11(5): 959-63.

Negri, A. L.(1996). Osteoporosis following heart transplantation. Transplant Proc 28(6): 3321-4.

Ramsey-Goldman, R.(1999). Increased risk of fracture in patients receiving solid organ transplants. Journal of Bone and Mineral Research 14(3): 456-463.

Rich, G. M.(1992). Cyclosporine A and prednisone-associated osteoporosis in heart transplant recipients. J Heart Lung Transplant 11(5): 950-8.

Rivas, M. D.(1993). Femoral-Neck Bone Loss Predominates 1 Year After Cardiac Transplantation. Journal of Bone and Mineral Research 8: S168-S168.

Rozenberg, S.(1995). Study of bone mineral density after cardiac transplantation. Transplant Proc 27(2): 1692-3.

Sambrook, P. N.(1994). Bone loss after heart transplantation: a prospective study. J Heart Lung Transplant 13(1 Pt 1): 116-20; discussion 121.

Sambrook, P. N.(1994). Mechanisms of Rapid Bone Loss Following Cardiac Transplantation. Osteoporosis International 4(5): 273-276.

Shane, E.(1993). Osteoporosis after cardiac transplantation. Am J Med 94(3): 257-64.

Shane, E.(1993). Bone Histomorphometry After Cardiac Transplantation. Journal of Bone and Mineral Research 8: S228-S228.

Shane, E.(1996). Fracture after cardiac transplantation: a prospective longitudinal study. J Clin Endocrinol Metab 81(5): 1740-6.

Shane, E.(1997). Comparison of two antiresorptive regimens on rates of bone loss after cardiac transplantation. Journal of Bone and Mineral Research 12: P319-P319.

Shane, E.(1997). A subset of patients lose bone after cardiac transplantation despite antiresorptive therapy. Journal of Bone and Mineral Research 12: F695-F695.

Shane, E.(1997). Bone loss and turnover after cardiac transplantation. Journal of Clinical Endocrinology and Metabolism 82(5): 1497-1506.

Shane, E.(1998). Prevention of bone loss after heart transplantation with antiresorptive therapy: A pilot study. Journal of Heart and Lung Transplantation 17(11): 1089-1096.

Stempfle, H. U.(1998). Rapid trabecular bone loss after cardiac transplantation using FK506 (tacrolimus)-based immunosuppression. Transplant Proc 30(4): 1132-3.

Thiebaud, D.(1996). Cyclosporine induces high bone turnover and may contribute to bone loss after heart transplantation. Eur J Clin Invest 26(7): 549-55.

VanCleemput, J.(1996). Prevention of bone loss in cardiac transplant recipients - A comparison of biphosphonates and vitamin D. Transplantation 61(10): 1495-1499.

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