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We studied whether bone biomarkers can predict high bone turnover determined by bone histomorphometry after kidney transplantation. We retrospectively evaluated the results of bone biopsy specimens obtained from kidney transplant recipients due to the clinical suspicion of high bone turnover between 2000 and 2015. Bone biomarkers were acquired concurrently. Of 813 kidney transplant recipients, 154 (19%) biopsies were taken at a median of 28 (interquartile range, 18\u201370) months after engraftment. Of 114 patients included in the statistical analysis, 80 (70%) presented with high bone turnover. Normal or low bone turnover was detected in 34 patients (30%). For discriminating high bone turnover from non-high, alkaline phosphatase, parathyroid hormone, and ionized calcium had the areas under the receiver operating characteristic curve (AUCs) of 0.704, 0.661, and 0.619, respectively. The combination of these markers performed better with an AUC of 0.775. The positive predictive value for high turnover at a predicted probability cutoff of 90% was 95% while the negative predictive value was 35%. This study concurs with previous observations that hyperparathyroidism with or without hypercalcemia does not necessarily imply high bone turnover in kidney transplant recipients. The prediction of high bone turnover can be improved by considering alkaline phosphatase levels, as presented in the logistic regression model. If bone biopsy is not readily available, this model may serve as clinically available tool in recognizing high turnover after engraftment.<\/jats:p>","DOI":"10.1007\/s00223-021-00917-1","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T16:47:06Z","timestamp":1634662026000},"page":"324-333","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Prediction of High-Turnover Bone Disease After Kidney Transplantation"],"prefix":"10.1007","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-5729","authenticated-orcid":false,"given":"Satu M.","family":"Keronen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena A. 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Keronen, Leena A. L. Martola, Patrik Finne, Inari S. Burton, Xiaoyu F. Tong, Heikki P. Kr\u00f6ger, Eero O. Honkanen have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"This study was approved by the Research Ethics Board of the Division of Medicine, Helsinki University Central Hospital (approval no. 413\/13\/03\/00\/09) and the Institutional Review Board of the Hospital District of Helsinki and Uusimaa (HUS\/33\/2010, HUS\/269\/2017 and HUS\/333\/2019) with the waiver of informed consent for medical record review.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All procedures performed in this study were in accordance with the Good Clinical Practice guidelines and ethical principles of the 1964 Declaration of Helsinki and its later amendments as well as with the principles of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights"}},{"value":"Informed consent was waived by The Research Ethics Board of the Division of Medicine, Helsinki University Central Hospital due to the retrospective type of the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}