Dr. Wang changming
Background: In the early phase of organ transplant, the emphasis of transplant medicine was the survival of graft or patients; With the development of medicine, the long-term survival of the recipient became very common phenomenon. Not only to survive, but to live high quality living is the new task of transplant medicine. Osteopathia is one of the disease that maybe influence the survival quality of the long-term survival patients.
Some concepts of osteopathia
Osteopenia
Osteoporosis: osteopenia and abnormal microstructure of the bone. NIH: osteoporosis means the abnormal framework of the bone, characterized as the decrease of the bone stength and the trend to be fractured. The abnormal bone density, microstructure, transformation, osteoclasia and repair can all cause abnormal bone strength.
BMD（Bone Mineral Density)≠Osteoporosis
Etiology
㈠ Pre-operation: common factors including, low body weight, malnutrition, abnormal metabolism of essential bone metabolism factors, such as 25-hydrovitamin D, parathyroid hormone and androgenic steroids.
㈡Post-operation:
⑴ Steriods
1、impairment of bone formmation;
2、acceralation of bone absorption;
3、secondary parathyrodism;
4、hypogonadism
⑵ Calcineurin inhibitors (FK506 /CsA)
1、favorable function, decreasing even stopping the use of steroids;
2、experimentally ex vivo, acceleration of bone absorption;
3、synergistic function with steroids;
Prevention of osteopathia
1、very important to prevent osteopathia before the operation, taking all possible measures to improve the metabolic status of the bone.
2、Measures to improve the metabolic status of the bone should be taken as one of the routine treatment after transplantation;
3、Evaluation of the bone metabolism status should be repeated done peri-operation, such as
X-ray of the spine; BMD determination of the spine, hip or the radium.
Prevention of the osteopathia-protocol
1、decreasing bone absorption-mainly bi-phosphates, such as Pamidronate, ibandronate, etc;
2、promoting the positive balance of calcium metabolism;
3、substitution treatment of sex hormone.
Prevention of osteopathia-suggestions
1、Decreasing as much as possible the iatrogenic factors, decreasing the dosage and duration of steroids premising the control of acute rejection;
2、Pay attention to the bone nutrition, improve the system status of the patients, especially the nutrition status;
3、Pay attention to the function exercise of the extremities early after the operation, decreasing in-bed time;
4、Properly supplement of calcium and vitamin D.