{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:45:49Z","timestamp":1790484349294,"version":"4.1.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010129","name":"Maud Kuistilan Muistos\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Disordered mineral metabolism reverses incompletely after kidney transplantation in numerous patients. Post-transplantation bone disease is a combination of pre-existing chronic kidney disease and mineral disorder and often evolving osteoporosis. These two frequently overlapping conditions increase the risk of post-transplantation fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>We studied the prevalence of low bone volume in bone biopsies obtained from kidney transplant recipients who were biopsied primarily due to the clinical suspicion of persistent hyperparathyroidism between 2000 and 2015 at the Hospital District of Helsinki and Uusimaa. Parameters of mineral metabolism, results of dual-energy x-ray absorptiometry scans, and the history of fractures were obtained concurrently.<\/jats:p>\n                    <jats:p>One hundred nine bone biopsies taken at a median of 31 (interquartile range, IQR, 18\u201370) months after transplantation were included in statistical analysis. Bone turnover was classified as high in 78 (72%) and normal\/low in 31 (28%) patients. The prevalence of low bone volume (n = 47, 43%) was higher among patients with low\/normal turnover compared to patients with high turnover [18 (58%) vs. 29 (37%), P = 0.05]. Thirty-seven fragility fractures in 23 (21%) transplant recipients corresponding to fracture incidence 15 per 1000 person-years occurred during a median follow-up 9.1 (IQR, 6.3\u201312.1) years. Trabecular bone volume did not correlate with incident fractures. Accordingly, low bone mineral density at the lumbar spine correlated with low trabecular bone volume, but not with incident fractures. The cumulative corticosteroid dose was an important determinant of low bone volume, but not of incident fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the high prevalence of trabecular bone loss among kidney transplant recipients, the number of fractures was limited. The lack of association between trabecular bone volume and fractures suggests that the bone cortical compartment and quality are important determinants of bone strength and post-transplantation fracture.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0261686","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T16:03:51Z","timestamp":1648569831000},"page":"e0261686","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bone volume, mineral density, and fracture risk after kidney transplantation"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-5729","authenticated-orcid":true,"given":"Satu","family":"Keronen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Martola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Finne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inari S.","family":"Burton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu F.","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Kr\u00f6ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eero","family":"Honkanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"issue":"4","key":"pone.0261686.ref001","doi-asserted-by":"crossref","first-page":"646","DOI":"10.2215\/CJN.06040614","article-title":"Comparison of Fracture Risk Prediction among Individuals with Reduced and Normal Kidney Function","volume":"10","author":"KL Naylor","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"pone.0261686.ref002","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/j.kint.2017.07.021","article-title":"Fractures in patients with CKD\u2014diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation","volume":"92","author":"A Pimentel","year":"2017","journal-title":"Kidney Int"},{"issue":"2","key":"pone.0261686.ref003","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.semnephrol.2009.01.006","article-title":"A Structural Approach to Skeletal Fragility in Chronic Kidney Disease","volume":"29","author":"MB Leonard","year":"2009","journal-title":"Semin Nephrol"},{"issue":"6","key":"pone.0261686.ref004","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1053\/j.ajkd.2013.12.016","article-title":"Fragility Fractures and Osteoporosis in CKD: Pathophysiology and Diagnostic Methods","volume":"63","author":"SN Salam","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"3","key":"pone.0261686.ref005","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s11914-017-0366-z","article-title":"Bone Quality in Chronic Kidney Disease: Definitions and Diagnostics","volume":"15","author":"EMB McNerny","year":"2017","journal-title":"Curr Osteoporos Rep"},{"issue":"10","key":"pone.0261686.ref006","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1111\/ajt.12425","article-title":"Persistent Hyperparathyroidism Is a Major Risk Factor for Fractures in the Five Years After Kidney Transplantation","volume":"13","author":"P Perrin","year":"2013","journal-title":"Am J Transplant"},{"issue":"4","key":"pone.0261686.ref007","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s10157-015-1117-z","article-title":"Mineral and bone disorders in kidney transplant recipients: reversible, irreversible, and de novo abnormalities","volume":"19","author":"T Hirukawa","year":"2015","journal-title":"Clin Exp Nephrol"},{"issue":"6","key":"pone.0261686.ref008","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1007\/s11914-018-0490-4","article-title":"Mineral and Bone Disease in Kidney Transplant Recipients","volume":"16","author":"A Altman","year":"2018","journal-title":"Curr Osteoporos Rep"},{"issue":"12","key":"pone.0261686.ref009","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1097\/TP.0b013e3181a6bbda","article-title":"Risk of Fractures After Renal Transplantation in the United States","volume":"87","author":"LE Nikkel","year":"2009","journal-title":"Transplantation"},{"issue":"12","key":"pone.0261686.ref010","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1097\/TP.0b013e31828eead8","article-title":"Fracture Risk in Kidney Transplant Recipients: A Systematic Review","volume":"95","author":"K Naylor","year":"2013","journal-title":"Transplantation"},{"issue":"8","key":"pone.0261686.ref011","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1097\/TP.0000000000001449","article-title":"Recent Changes in Chronic Kidney Disease\u2013Mineral and Bone Disorders and Associated Fractures After Kidney Transplantation","volume":"101","author":"P Perrin","year":"2017","journal-title":"Transplantation"},{"issue":"4","key":"pone.0261686.ref012","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/ajt.12652","article-title":"Temporal Trends in the Incidence, Treatment and Outcomes of Hip Fracture After First Kidney Transplantation in the United States","volume":"14","author":"SS Nair","year":"2014","journal-title":"Am J Transplant"},{"key":"pone.0261686.ref013","first-page":"541","volume-title":"Principles and Practice of Endocrinology and Metabolism","author":"DW Dempster","year":"2001","edition":"3"},{"issue":"12","key":"pone.0261686.ref014","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1111\/j.1600-6143.2008.02423.x","article-title":"Can DXA Predict Fractures in Renal Transplant Patients?","volume":"8","author":"S Akaberi","year":"2008","journal-title":"Am J Transplant"},{"issue":"6","key":"pone.0261686.ref015","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":"P Evenepoel","year":"2019","journal-title":"Kidney Int"},{"issue":"1","key":"pone.0261686.ref016","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","volume":"36","author":"P Evenepoel","year":"2020","journal-title":"Nephrol Dial Transplant."},{"issue":"9","key":"pone.0261686.ref017","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A New Equation to Estimate Glomerular Filtration Rate","volume":"150","author":"AS Levey","year":"2009","journal-title":"Ann Intern Med"},{"issue":"3","key":"pone.0261686.ref018","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5414\/CN108709","article-title":"Bone histomorphometry and indicators of bone and mineral metabolism in wait-listed dialysis patients","volume":"85","author":"S Keronen","year":"2016","journal-title":"Clin Nephrol"},{"issue":"4","key":"pone.0261686.ref019","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5414\/CNP65235","article-title":"Renal osteodystrophy: What\u2019s in a name? Presentation of a clinically useful new model to interpret bone histologic findings","volume":"65","author":"HH Malluche","year":"2006","journal-title":"Clin Nephrol"},{"issue":"6","key":"pone.0261686.ref020","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1136\/jcp.47.6.529","article-title":"Age related histomorphometric changes in bone in normal British men and women","volume":"47","author":"MT Rehman","year":"1994","journal-title":"J of Clin Pathol"},{"issue":"1","key":"pone.0261686.ref021","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1002\/jbmr.1805","article-title":"Standardized nomenclature, symbols, and units for bone histomorphometry: A 2012 update of the report of the ASBMR Histomorphometry Nomenclature Committee","volume":"28","author":"DW Dempster","year":"2013","journal-title":"J Bone Miner Res"},{"issue":"7","key":"pone.0261686.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v074.i07","article-title":"Imputation with the R Package # VIM","volume":"74","author":"A Kowarik","year":"2016","journal-title":"J Stat Softw"},{"key":"pone.0261686.ref023","volume-title":"Practical statistics for medical research","author":"DG Altman","year":"1991","edition":"1"},{"issue":"5","key":"pone.0261686.ref024","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1053\/j.ajkd.2017.12.019","article-title":"Menopause in CKD","volume":"71","author":"K Vellanki","year":"2018","journal-title":"Am J Kidney Dis"},{"issue":"11","key":"pone.0261686.ref025","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1111\/j.1600-6143.2007.01950.x","article-title":"Low-Turnover Bone Disease in Hypercalcemic Hyperparathyroidism After Kidney Transplantation","volume":"7","author":"K Borchhardt","year":"2007","journal-title":"Am J Transplant"},{"issue":"10","key":"pone.0261686.ref026","doi-asserted-by":"crossref","first-page":"3153","DOI":"10.1016\/j.transproceed.2007.10.001","article-title":"Renal Osteodystrophy After Successful Renal Transplantation: A Histomorphometric Analysis in 57","volume":"39","author":"G Lehmann","year":"2007","journal-title":"Patients. Transplant Proc"},{"issue":"3","key":"pone.0261686.ref027","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/TP.0b013e3182985468","article-title":"Persistence of Bone and Mineral Disorders 2 Years After Successful Kidney Transplantation","volume":"96","author":"C Neves","year":"2013","journal-title":"Transplantation"},{"issue":"1","key":"pone.0261686.ref028","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/nep.12570","article-title":"Evolution of bone disease after kidney transplantation: A prospective histomorphometric analysis of trabecular and cortical bone","volume":"21","author":"C Carvalho","year":"2016","journal-title":"Nephrology"},{"issue":"2","key":"pone.0261686.ref029","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.kint.2016.10.008","article-title":"Bone histomorphometry in de novo renal transplant recipients indicates a further decline in bone resorption 1 year posttransplantation","volume":"91","author":"P Evenepoel","year":"2017","journal-title":"Kidney Int"},{"issue":"6","key":"pone.0261686.ref030","doi-asserted-by":"crossref","first-page":"894","DOI":"10.2215\/CJN.09950818","article-title":"Changes in Bone Histomorphometry after Kidney Transplantation","volume":"14","author":"S Keronen","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"issue":"2","key":"pone.0261686.ref031","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1681\/ASN.2018060656","article-title":"A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation","volume":"30","author":"IDB Marques","year":"2019","journal-title":"J Am Soc Nephrol"},{"issue":"3","key":"pone.0261686.ref032","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1600-6143.2011.03872.x","article-title":"Reduced Fracture Risk With Early Corticosteroid Withdrawal After Kidney Transplant","volume":"12","author":"LE Nikkel","year":"2012","journal-title":"Am J Transplant"},{"issue":"4","key":"pone.0261686.ref033","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1093\/ndt\/gfy306","article-title":"Natural history of mineral metabolism, bone turnover and bone mineral density in de novo renal transplant recipients treated with a steroid minimization immunosuppressive protocol","volume":"35","author":"P Evenepoel","year":"2018","journal-title":"Nephrol Dial Transplant"},{"issue":"1","key":"pone.0261686.ref034","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/ndt\/gfr317","article-title":"Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients-a single-center cohort study","volume":"27","author":"S Iimori","year":"2012","journal-title":"Nephrol Dial Transplant."},{"issue":"1","key":"pone.0261686.ref035","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/TP.0000000000000808","article-title":"Fracture Incidence in Adult Kidney Transplant Recipients","volume":"100","author":"KL Naylor","year":"2016","journal-title":"Transplantation"},{"issue":"9","key":"pone.0261686.ref036","doi-asserted-by":"crossref","first-page":"e13347","DOI":"10.1111\/ctr.13347","article-title":"Changes in bone microarchitecture following kidney transplantation-Beyond bone mineral density","volume":"32","author":"AK Sharma","year":"2018","journal-title":"Clin Transplant"},{"issue":"8","key":"pone.0261686.ref037","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1002\/jbmr.1916","article-title":"Rapid cortical bone loss in patients with chronic kidney disease","volume":"28","author":"TL Nickolas","year":"2013","journal-title":"J Bone Miner Res"},{"issue":"1","key":"pone.0261686.ref038","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00198-017-4228-4","article-title":"Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors","volume":"29","author":"HH Malluche","year":"2017","journal-title":"Osteoporos Int"},{"issue":"6","key":"pone.0261686.ref039","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1159\/000489671","article-title":"Deterioration of Cortical Bone Microarchitecture: Critical Component of Renal Osteodystrophy Evaluation","volume":"47","author":"A Sharma","year":"2018","journal-title":"Am J Nephrol"},{"issue":"7","key":"pone.0261686.ref040","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.2215\/CJN.11371015","article-title":"Bone Disease after Kidney Transplantation","volume":"11","author":"A Bouquegneau","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"issue":"9","key":"pone.0261686.ref041","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.1016\/j.transproceed.2010.06.027","article-title":"Cinacalcet improves bone density in post-kidney transplant hyperparathyroidism","volume":"42","author":"M Cho","year":"2010","journal-title":"Transplant Proc"},{"issue":"6","key":"pone.0261686.ref042","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1159\/000489672","article-title":"Cortical or Trabecular Bone: What\u2019s the Difference?","volume":"47","author":"M Ott Susan","year":"2018","journal-title":"Am J Nephrol"},{"issue":"10","key":"pone.0261686.ref043","first-page":"1608","article-title":"Bone biopsy practice patterns across Europe: the European renal osteodystrophy initiative: a position paper","volume":"32","author":"P Evenepoel","year":"2017","journal-title":"Nephrol Dial Transplant"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T16:04:27Z","timestamp":1648569867000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261686"}},"subtitle":[],"editor":[{"given":"Pierre","family":"Delanaye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,29]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261686","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,29]]}}}