Serum phosphorus levels and fracture following renal transplantation

Abstract

Purpose

Increased fracture rates are observed in renal transplant recipients (RTRs) compared with the general population. Risk factors include age, diabetes, dialysis vintage, immunosuppression, and mineral and bone disorders(1). Low serum phosphorus levels occur post-transplantation; however its relationship with fracture risk has not been evaluated. The purpose of this study was to evaluate risk factors for fracture in RTRs at a single tertiary referral centre.

Methods

A retrospective cross-sectional analysis of 146 patients (75M, 71F) who had been referred for dual energy x-ray densitometry (DXA) post-renal transplantation was performed. Aetiology of end stage kidney disease (ESKD), duration of dialysis, parathyroidectomy history, immunosuppression regimen, bone mineral density (BMD), biochemistry and fractures were documented. Statistical analyses included univariable and multivariable regression.

Results

The mean age of patients was 54 years and mean time post-transplantation 6.7 years. 79 fractures occurred in 52 patients (35%), with 40 fractures occurring post-transplantation. Ankle/foot fractures were most common (48%). Lower serum phosphorus levels and declining FN T-score and were associated with fractures in both univariable and multivariable regression analyses after adjusting for age, gender, weight, eGFR and pre-transplant history of fracture (p=0.011 and p=0.042 respectively). The relationship between serum phosphorus and fracture remained significant independent of FN T-score, parathyroid hormone levels, parathyroidectomy status and prednisolone use.

Conclusion

Fracture was common post-renal transplantation. Lower serum phosphorus levels and declining FN T-scores were associated with fractures. The mechanism of this previously unreported observation requires further evaluation in prospective studies.

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