{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:45:52Z","timestamp":1792683952767,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Bone loss and fractures are critical post\u2010kidney transplantation (KT) complications. We evaluated age\u2010stratified screening practices, treatment patterns, and fracture incidence in a nationwide KT cohort.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using the Korean National Health Insurance Service database (2003\u20132020), we analyzed 34\u00a0758 adult KT recipients. Screening practices (bone mineral density [BMD] testing), medication continuity, and incident fractures were assessed across age groups (< 50, 50\u201364, \u2265 65 years).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n During a median follow\u2010up of 8.4 years, 63.8% of recipients underwent BMD testing, but only 29.9% were screened within the first year post\u2010transplant. Overall fracture incidence was 1.2\/100 person\u2010years (PY), increasing to 3.9\/100 PY in recipients aged \u2265 65 (IRR 5.41\u00a0vs. < 50 years). The excess fracture risk in older recipients persisted across all post\u2010transplant time intervals (adjusted SHR 4.18, 4.23, and 3.61 for < 1, 1\u20135, and \u2265 5 years, respectively). Despite a 5.2\u2010 to 7.6\u2010fold increase in post\u2010KT fracture risk associated with a pre\u2010transplant fracture history, screening practices were not consistently intensified among younger patients with prior fractures.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Post\u2010transplant bone health management is characterized by delayed assessment and insufficient risk\u2010stratified screening. Risk\u2010adapted strategies are necessary to improve early screening and sustained therapy, particularly for high\u2010risk recipients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ctr.70704","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:26:29Z","timestamp":1792682789000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Discordance Between Fracture Risk and Bone Health Management After Kidney Transplantation: A Nationwide Cohort Study"],"prefix":"10.1111","volume":"40","author":[{"given":"Ji Eun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"},{"name":"Department of Internal Medicine Korea University College of Medicine Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Mi","family":"Park","sequence":"additional","affiliation":[{"name":"Biomedical Research Center Korea University Guro Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Min","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Woo","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Jung","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang Jee","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"},{"name":"Department of Internal Medicine Korea University College of Medicine Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Joo","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Korea University Guro Hospital Seoul South Korea"},{"name":"Department of Internal Medicine Korea University College of Medicine Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"23","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of Mortality in all Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant","volume":"341","author":"Wolfe R. A.","year":"1999","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1038\/ki.1996.307","article-title":"A Study of the Quality of Life and Cost\u2010Utility of Renal Transplantation","volume":"50","author":"Laupacis A.","year":"1996","journal-title":"Kidney International"},{"issue":"9","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1056\/NEJM200003023420901","article-title":"Improved Graft Survival After Renal Transplantation in the United States, 1988 to 1996","volume":"342","author":"Hariharan S.","year":"2000","journal-title":"New England Journal of Medicine"},{"issue":"6","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.kint.2018.12.024","article-title":"Bone Mineral Density, Bone Turnover Markers, and Incident Fractures in De Novo Kidney Transplant Recipients","volume":"95","author":"Evenepoel P.","year":"2019","journal-title":"Kidney International"},{"issue":"10","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s00198-007-0394-0","article-title":"Glucocorticoid\u2010Induced Osteoporosis: Pathophysiology and Therapy","volume":"18","author":"Canalis E.","year":"2007","journal-title":"Osteoporosis International"},{"issue":"4","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1038\/ki.2013.547","article-title":"The Three\u2010Year Incidence of Fracture in Chronic Kidney Disease","volume":"86","author":"Naylor K. L.","year":"2014","journal-title":"Kidney International"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2023.1167574","article-title":"High Risk of Osteoporosis and Fracture Following Solid Organ Transplantation: A Population\u2010Based Study","volume":"14","author":"Chen H.","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/jbm4.10067","article-title":"Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review","volume":"3","author":"Sidibe A.","year":"2019","journal-title":"JBMR Plus"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jcte.2024.100345","article-title":"Bone Health and Fracture Prevention After Kidney Transplantation","volume":"36","author":"Jaikaransingh V.","year":"2024","journal-title":"Journal of Clinical and Translational Endocrinology"},{"issue":"1","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.kint.2017.04.006","article-title":"Executive Summary of the 2017 KDIGO Chronic Kidney Disease\u2010Mineral and Bone Disorder (CKD\u2010MBD) Guideline Update: What's Changed and Why It Matters","volume":"92","author":"Ketteler M.","year":"2017","journal-title":"Kidney International"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40697-016-0092-y","article-title":"Frequency of Bone Mineral Density Testing in Adult Kidney Transplant Recipients From Ontario, Canada: A Population\u2010Based Cohort Study","volume":"3","author":"Naylor K. L.","year":"2016","journal-title":"Canadian Journal of Kidney Health and Disease"},{"issue":"4","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.11005\/jbm.2020.27.4.281","article-title":"Osteoporosis and Osteoporotic Fracture Fact Sheet in Korea","volume":"27","author":"Ahn S. H.","year":"2020","journal-title":"Journal of Bone Metabolism"},{"issue":"3","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2018.33.e20","article-title":"Utilization of Osteoporosis\u2010Related Health Services: Use of Data From the Korean National Health Insurance Database 2008\u20102012","volume":"33","author":"Yu T. Y.","year":"2018","journal-title":"Journal of Korean Medical Science"},{"issue":"6","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.3390\/jcm12062337","article-title":"Time\u2010Varying Risk Factors for Incident Fractures in Kidney Transplant Recipients: A Nationwide Cohort Study in South Korea","volume":"12","author":"Eum S. 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M.","year":"2020","journal-title":"Endocrine Practice"},{"issue":"3","key":"e_1_2_9_18_1","first-page":"S1","article-title":"KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients","volume":"9","author":"Kidney Disease: Improving Global Outcomes Transplant Work G","year":"2009","journal-title":"American Journal of Transplantation"},{"issue":"1","key":"e_1_2_9_19_1","first-page":"1","article-title":"KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease\u2010Mineral and Bone Disorder (CKD\u2010MBD)","volume":"7","author":"Kidney Disease: Improving Global Outcomes CKDMBDUWG","year":"2017","journal-title":"Kidney International Supplements"},{"issue":"1","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/ndt\/gfaa192","article-title":"European Consensus Statement on the Diagnosis and Management of Osteoporosis in Chronic Kidney Disease Stages G4\u2010G5D","volume":"36","author":"Evenepoel P.","year":"2021","journal-title":"Nephrology, Dialysis, Transplantation"},{"issue":"6","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.3904\/kjim.2019.292","article-title":"Characteristics of Kidney Transplantation Recipients Over Time in South Korea","volume":"35","author":"Park S.","year":"2020","journal-title":"Korean Journal of Internal Medicine"},{"issue":"12","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","DOI":"10.1097\/TXD.0000000000001520","article-title":"Evolving Trends in Kidney Transplant Outcomes among Older Adults: A Comparative Analysis Before and During the COVID\u201019 Pandemic","volume":"9","author":"Li Y.","year":"2023","journal-title":"Transplant Direct"},{"issue":"9","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/01.TP.0000438200.84154.1a","article-title":"FRAX Predicts Fracture Risk in Kidney Transplant Recipients","volume":"97","author":"Naylor K. 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L.","year":"2019","journal-title":"Journal of the American Geriatrics Society"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70704","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70704","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70704","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:26:35Z","timestamp":1792682795000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ctr.70704"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70704","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70704"}}