BACKGROUND:Complex and longstanding bone disease superimposed by harmful influences of immunosuppression is the reason for increased risk of bone fracture in kidney transplant recipients. The aim of our study was to analyze the incidence and prevalence of nonvertebral bone fractures and early (in the first post-transplant year) clinical and laboratory risk factors for suffering bone fracture in the long-term post-transplant period. METHODS:Clinical and laboratory data as well as bone mineral density (BMD) measurements of 507 first kidney transplant recipients who were transplanted in the period from 1976 to 2011 were analyzed. RESULTS:The mean age of included patients was 54.3 ± 12.0 years, there were 45% females, and mean time on renal replacement treatment prior to transplantation was 63.4 ± 43.6 months. The average observation time post-transplant was 9.7 years (1.4 - 36.3 years). Post-transplant, 64 (12.6%) patients suffered 89 nonvertebral fractures (44 patients suffered 1 fracture, 15 patients 2 fractures, and 5 patients 3 fractures). Patients with fractures had significantly lower late BMD of femoral neck in the period of 1 - 10 years post-transplant, had osteopenia and osteoporosis more frequently in the same time period, and higher serum alkaline phosphatase in the first year post-transplant. 13 patients (13/64, 20.3%) had major fractures. Patients with major fractures were significantly older than patients with no major fractures and had lower serum albumin. Frequency of treatment with bisphosphonate, calcium, or phosphate did not differ between the groups. Vitamin D supplement (active form in 98% of cases) was prescribed more frequently in the group without fractures, but this was not statistically significant. CONCLUSION:Fracture rate in our transplant patient population was comparable to that reported in the literature. Except for a higher level of serum total alkaline phosphatase in the fracture group, we found no other early laboratory risk factors for bone fractures. BMD at the femoral region 1 - 10 years after kidney transplantation but not BMD at the time of transplantation was a risk factor for nonvertebral fractures. Osteopenia and osteoporosis in the post-transplant period were found to be a fracture risk factor.
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译文

背景:复杂且长期存在的骨病,加上免疫抑制的有害影响,是肾移植受者发生骨折风险增加的原因。我们的研究目的是分析非椎骨骨折的发生率和患病率,以及早期(在移植后的第一年)临床和实验室在长期移植后遭受骨折的危险因素。
方法:分析了1976年至2011年间移植的507名首批肾移植受者的临床和实验室数据以及骨矿物质密度(BMD)。
结果:纳入患者的平均年龄为54.3±12.0岁,女性为45%,移植前接受肾脏替代治疗的平均时间为63.4±43.6个月。移植后的平均观察时间为9.7年(1.4-36.3年)。移植后,有64例(12.6%)患者发生了89例非椎骨骨折(44例患者发生了1例骨折,15例患者发生了2例骨折,5例患者发生了3例骨折)。骨折患者在移植后1-10年内股骨颈的晚期BMD明显降低,在同一时期内骨质疏松症和骨质疏松症的发生频率更高,并且在移植后第一年的血清碱性磷酸酶升高。重度骨折13例(13/64,20.3%)。严重骨折的患者明显比没有严重骨折的患者大,血清白蛋白较低。两组之间用双膦酸盐,钙或磷酸盐治疗的频率没有差异。在无骨折的人群中,更频繁地开具维生素D补充剂(98%的病例为活性形式),但这在统计学上没有统计学意义。
结论:我们移植患者的骨折率与文献报道的相当。除了骨折组中血清总碱性磷酸酶水平升高外,我们没有发现其他早期实验室危险因素导致骨折。肾移植后1-10年,股骨区域的BMD而非移植时的BMD是非椎骨骨折的危险因素。发现移植后骨质减少和骨质疏松是骨折的危险因素。 。

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