Bone Disease in Long-term Renal Transplant Recipients with Severe Osteopenia: A Cross-sectional Study

Background. Fracture is a disabling clinical outcome after transplantation, but there is little histopathological information on long-term renal recipients with severe osteopenia. Methods. Twenty kidney recipients (8.3±1.9 years after transplantation), 13 males and 7 females (five postmenopausal) with nearly normal renal function, affected by severe osteopenia (T-score: males= -4.9±0.28; females= -5.08±0.47) underwent bone biopsy and morphometric X-ray absorptiometry to evaluate vertebral fractures. Results. Histopathological diagnosis was osteoporosis-osteopenia in seven patients, osteitis fibrosa in six, prevalent osteomalacic lesion in six, and "normal" bone in one patient. Significant increases in osteoid volume (OV/BV), osteoid surface, osteoblastic surface (ObS/BS) and osteoid thickness were observed. OV/BV and Obs/BS ratios were inversely correlated to cumulative doses of MPRED (r 2 = 0.85 P