Metabolic bone disease continues to influence morbidity and mortality after a successful transplant. Despite normalisation of phosphate excretion and improved activation of vitamin D, parathyroid hormone levels can remain elevated. Bone resorption continues due to the adverse effects of corticosteroids on osteoblast function and calcium absorption from the gut. Type 1 diabetic transplant recipients have been reported to have a higher fracture rate than non-diabetic recipients (40% vs 11%) (29). This increased fracture rate is similar in the male and female diabetic subjects, and contrasts with results from the non-diabetic transplant recipients in whom the female fracture rate is approximately twice that of men. Increased intake of dietary calcium and the use of calcitriol and alendronate can help to neutralise the adverse effect of corticosteroids.
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