{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:15:26Z","timestamp":1791321326322,"version":"4.3.1"},"reference-count":95,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease\u2013mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation.<\/jats:p>","DOI":"10.3390\/ijms25031859","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T05:22:44Z","timestamp":1707110564000},"page":"1859","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3846-142X","authenticated-orcid":false,"given":"Jia Wei","family":"Teh","sequence":"first","affiliation":[{"name":"Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conall","family":"Mac Gearailt","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W. P.","family":"Lappin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland"},{"name":"School of Medicine, University of Galway, H91 TK33 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,3]]},"reference":[{"key":"ref_1","first-page":"4477","article-title":"KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease","volume":"19","author":"Eknoyan","year":"2014","journal-title":"IFAC Proc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000514550","article-title":"Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy","volume":"52","author":"Thurlow","year":"2021","journal-title":"Am. J. Nephrol."},{"key":"ref_3","unstructured":"United States Renal Data System (2024, January 24). 2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States\u2014Incidence, Prevalence, Patient Characteristics, and Treatment Modalities Highlights, Available online: https:\/\/usrds-adr.niddk.nih.gov\/2022\/end-stage-renal-disease\/1-incidence-prevalence-patient-characteristics-and-treatment-modalities."},{"key":"ref_4","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","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"471","DOI":"10.2215\/CJN.05021107","article-title":"Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation\/Kidney Disease Outcomes Quality Initiative (NKF\/KDOQITM) Conference","volume":"3","author":"Abecassis","year":"2008","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_6","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":"Nair","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.2215\/CJN.11371015","article-title":"Bone Disease after Kidney Transplantation","volume":"11","author":"Bouquegneau","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Group KDIGO (KDIGO) (2017). KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease\u2013Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 7, 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.semnephrol.2012.12.019","article-title":"Recovery Versus Persistence of Disordered Mineral Metabolism in Kidney Transplant Recipients","volume":"33","author":"Evenepoel","year":"2013","journal-title":"Semin. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/BF01622200","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report","volume":"4","author":"Kanis","year":"1994","journal-title":"Osteoporos. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s00223-021-00837-0","article-title":"Bone Mineral Disease After Kidney Transplantation","volume":"108","author":"Torregrosa","year":"2021","journal-title":"Calcif. Tissue Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1681\/ASN.2013080851","article-title":"Kidney Transplantation with early corticosteroid withdrawal: Paradoxical effects at the central and peripheral skeleton","volume":"25","author":"Iyer","year":"2014","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/SLA.0000000000001431","article-title":"How well does renal transplantation cure hyperparathyroidism?","volume":"262","author":"Lou","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1093\/ndt\/gfh128","article-title":"Natural history of parathyroid function and calcium metabolism after kidney transplantation: A single-centre study","volume":"19","author":"Evenepoel","year":"2004","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/TP.0000000000000823","article-title":"A Prospective Cohort Study of Mineral Metabolism After Kidney Transplantation","volume":"100","author":"Wolf","year":"2016","journal-title":"Transplantation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1093\/oxfordjournals.ndt.a027676","article-title":"Bone demineralization after renal transplantation: Contribution of secondary hyperparathyroidism manifested by hypercalcaemia","volume":"11","author":"Setterberg","year":"1996","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_17","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":"Perrin","year":"2017","journal-title":"Transplantation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"665","DOI":"10.2215\/CJN.03920808","article-title":"Calcium Metabolism in the Early Posttransplantation Period","volume":"4","author":"Evenepoel","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/j.1600-6143.2007.01753.x","article-title":"Tertiary \u2018Hyperphosphatoninism\u2019 Accentuates Hypophosphatemia and Suppresses Calcitriol Levels in Renal Transplant Recipients","volume":"7","author":"Evenepoel","year":"2007","journal-title":"Am. J. Transplant."},{"key":"ref_20","unstructured":"Sizar, O., Khare, S., Goyal, A., and Givler, A. (2024, January 09). Vitamin D Deficiency. [Updated 2023 Jul 17], StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532266\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1097\/TP.0b013e3181d62f1b","article-title":"The KDIGO Clinical Practice Guidelines for the Care of Kidney Transplant Recipients","volume":"89","author":"Chapman","year":"2010","journal-title":"Transplantation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1681\/ASN.V1161093","article-title":"High prevalence of low bone turnover and occurrence of osteomalacia after kidney transplantation","volume":"11","author":"Mawad","year":"2000","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1038\/sj.ki.5000414","article-title":"Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"69","author":"Moe","year":"2006","journal-title":"Kidney Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1148\/radiol.11111044","article-title":"Micro\u2013MR imaging\u2013based computational biomechanics demonstrates reduction in cortical and trabecular bone strength after renal transplantation","volume":"262","author":"Rajapakse","year":"2012","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1002\/jbmr.1947","article-title":"Bone stiffness and failure load are related with clinical parameters in men with chronic obstructive pulmonary disease","volume":"28","author":"Romme","year":"2013","journal-title":"J. Bone Miner. Res."},{"key":"ref_26","unstructured":"NOGG UK National Osteoporosis Guidline Group\u2014UK (2023, November 13). 72. Available online: https:\/\/www.nogg.org.uk\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1111\/j.1523-1755.2000.00394.x","article-title":"Risk factors for hip fracture among patients with end-stage renal disease","volume":"58","author":"Sherrard","year":"2000","journal-title":"Kidney Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1210\/jc.2010-2135","article-title":"Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture","volume":"96","author":"Bours","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00223-020-00779-z","article-title":"Bone Fragility Fractures in CKD Patients","volume":"108","author":"Pimentel","year":"2021","journal-title":"Calcif. Tissue Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00198-013-2435-1","article-title":"Incidence and risk factors for hip fractures in dialysis patients","volume":"25","author":"Maravic","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1038\/sj.ki.5001754","article-title":"Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study","volume":"70","author":"Jadoul","year":"2006","journal-title":"Kidney Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1046\/j.1523-1755.2000.00178.x","article-title":"Increased risk of hip fracture among patients with end-stage renal disease","volume":"58","author":"Alem","year":"2000","journal-title":"Kidney Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/tri.12697","article-title":"Vitamin D deficiency is an independent risk factor for PTDM after kidney transplantation","volume":"29","author":"Fournier","year":"2016","journal-title":"Transpl. Int."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kovvuru, K., Kanduri, S.R., Vaitla, P., Marathi, R., Gosi, S., Anton, D.F.G., Rivera, F.H.C., and Garla, V. (2020). Risk factors and management of osteoporosis post-transplant. Medicina, 56.","DOI":"10.3390\/medicina56060302"},{"key":"ref_35","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":"Evenepoel","year":"2017","journal-title":"Kidney Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.bone.2012.11.006","article-title":"Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women","volume":"52","author":"Edwards","year":"2013","journal-title":"Bone"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wu, P.Y., Chao, C.-T., Chan, D.-C., Huang, J.-W., and Hung, K.-Y. (2019). Contributors, risk associates, and complications of frailty in patients with chronic kidney disease: A scoping review. Ther. Adv. Chronic Dis., 10.","DOI":"10.1177\/2040622319880382"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.amjmed.2009.01.026","article-title":"Frailty and Chronic Kidney Disease: The Third National Health and Nutrition Evaluation Survey","volume":"122","author":"Hall","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1093\/ckj\/sfx134","article-title":"Frailty and chronic kidney disease: Current evidence and continuing uncertainties","volume":"11","author":"Nixon","year":"2018","journal-title":"Clin. Kidney J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1097\/CM9.0000000000002312","article-title":"Frailty in kidney transplant candidates and recipients: Pathogenesis and intervention strategies","volume":"136","author":"Cao","year":"2023","journal-title":"Chin. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.gaitpost.2019.12.031","article-title":"Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study","volume":"76","author":"Zanotto","year":"2020","journal-title":"Gait Posture"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"73","DOI":"10.6002\/ect.TOND-TDTD2019.P19","article-title":"Effect of Kidney Transplant on Balance and Fall Risk","volume":"18","author":"Tekkarismaz","year":"2020","journal-title":"Exp. Clin. Transpl."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1111\/jgs.13657","article-title":"Changes in Frailty After Kidney Transplantation","volume":"63","author":"Isaacs","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_45","unstructured":"Kanis, J.A. (2007). Assessment of Osteoporosis at the Primary Health Care Level, World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield."},{"key":"ref_46","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\u2013G5D","volume":"36","author":"Evenepoel","year":"2021","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_47","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":"Naylor","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00198-013-2524-1","article-title":"The clinical utility of FRAX to discriminate fracture status in men and women with chronic kidney disease","volume":"25","author":"Jamal","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_49","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","year":"2014","journal-title":"Transplantation"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Ribeiro, L.C., Almeida, M., Malheiro, J., Silva, F., Nunes-Carneiro, D., Martins, L.S., Pedroso, S., and Silva-Ramos, M. (2023). Association of the Calcification Score of the Abdominal Aorta, Common Iliac, and Renal Arteries with Outcomes in Living Kidney Donors. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093339"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000518670","article-title":"Progression of Aortic Calcification in Stage 4\u20135 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation","volume":"47","author":"Lankinen","year":"2022","journal-title":"Kidney Blood Press. Res."},{"key":"ref_52","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":"Akaberi","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1177\/106002809903301207","article-title":"Book Review: Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis","volume":"33","year":"1999","journal-title":"Ann. Pharmacother."},{"key":"ref_54","first-page":"S1","article-title":"2002 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada","volume":"167","author":"Brown","year":"2002","journal-title":"C. Can. Med. Assoc. J."},{"key":"ref_55","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":"Naylor","year":"2013","journal-title":"Transplantation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/ckj\/sfac265","article-title":"Drugs associated with incident fragility fractures in kidney transplant recipients","volume":"16","author":"Batteux","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1159\/000534019","article-title":"Coexistence of low muscle mass and osteoporosis as a predictor of fragility fractures in long-term kidney transplant recipients","volume":"54","author":"Hori","year":"2023","journal-title":"Am. J. Nephrol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Hu, L., Napoletano, A., Provenzano, M., Garofalo, C., Bini, C., Comai, G., and La Manna, G. (2022). Mineral Bone Disorders in Kidney Disease Patients: The Ever-Current Topic. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232012223"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1053\/j.ajkd.2015.06.023","article-title":"Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients with CKD Treated by Dialysis","volume":"67","author":"Sprague","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1111\/j.1600-6143.2008.02327.x","article-title":"Effect of Teriparatide on Early Bone Loss After Kidney Transplantation","volume":"8","author":"Cejka","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_61","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":"Iimori","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1159\/000510565","article-title":"Predictive Power of Bone Turnover Biomarkers to Estimate Bone Mineral Density after Kidney Transplantation with or without Denosumab: A post hoc Analysis of the POSTOP Study","volume":"45","author":"Heimgartner","year":"2020","journal-title":"Kidney Blood Press. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1093\/ckj\/sfac230","article-title":"Management of fracture risk in CKD\u2014Traditional and novel approaches","volume":"16","author":"Haarhaus","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2215\/CJN.03410321","article-title":"Bone and Mineral Disease in Kidney Transplant Recipients","volume":"17","author":"Khairallah","year":"2022","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_65","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":"Nikkel","year":"2012","journal-title":"Am. J. Transplant."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s00198-003-1532-y","article-title":"Long-term fracture risk following renal transplantation: A population-based study","volume":"15","author":"Vautour","year":"2004","journal-title":"Osteoporos. Int."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1001\/jamasurg.2020.6929","article-title":"Early Corticosteroid Cessation vs Long-term Corticosteroid Therapy in Kidney Transplant Recipients: Long-term Outcomes of a Randomized Clinical Trial","volume":"156","author":"Woodle","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Haller, M.C., Kammer, M., Kainz, A., Baer, H.J., Heinze, G., and Oberbauer, R. (2017). Steroid withdrawal after renal transplantation: A retrospective cohort study. BMC Med., 15.","DOI":"10.1186\/s12916-016-0772-6"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ekir.2021.11.028","article-title":"A Randomized Controlled Trial on Safety of Steroid Avoidance in Immunologically Low-Risk Kidney Transplant Recipients","volume":"7","author":"Ekberg","year":"2022","journal-title":"Kidney Int. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know","volume":"96","author":"Ross","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Palmer, S.C., McGregor, D.O., and Strippoli, G.F. (2007). Interventions for preventing bone disease in kidney transplant recipients. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD005015.pub3"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/j.1399-0012.2007.00696.x","article-title":"Prevalence of 25(OH) vitamin D (calcidiol) deficiency at time of renal transplantation: A prospective study","volume":"21","author":"Sadlier","year":"2007","journal-title":"Clin. Transplant."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1002\/jbmr.4469","article-title":"Cholecalciferol Supplementation Attenuates Bone Loss in Incident Kidney Transplant Recipients: A Prespecified Secondary Endpoint Analysis of a Randomized Controlled Trial","volume":"37","author":"Tsujita","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/01.TP.0000149322.70295.A5","article-title":"A controlled study of vitamin D3 to prevent bone loss in renal-transplant patients receiving low doses of steroids","volume":"79","author":"Wissing","year":"2005","journal-title":"Transplantation"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1681\/ASN.2013111185","article-title":"Paricalcitol for secondary hyperparathyroidism in renal transplantation","volume":"26","author":"Trillini","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1111\/ajt.12227","article-title":"Oral paricalcitol reduces the prevalence of posttransplant hyperparathyroidism: Results of an open label randomized trial","volume":"13","author":"Amer","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.4065\/83.9.1032","article-title":"Bisphosphonates: Mechanism of Action and Role in Clinical Practice","volume":"83","author":"Drake","year":"2008","journal-title":"Mayo Clin. Proc."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"101178","DOI":"10.1016\/j.bonr.2022.101178","article-title":"Bisphosphonates and bone mineral density in patients with end-stage kidney disease and renal transplants: A 15-year single-centre experience","volume":"16","author":"Hauck","year":"2022","journal-title":"Bone Rep."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000276666","article-title":"Bisphosphonate use in chronic kidney disease: Association with adynamic bone disease in a bone histology series","volume":"29","author":"Amerling","year":"2010","journal-title":"Blood Purif."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1038\/nrd3705","article-title":"Bench to bedside: Elucidation of the OPG\u2013RANK\u2013RANKL pathway and the development of denosumab","volume":"11","author":"Lacey","year":"2012","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1111\/ajt.13692","article-title":"Effect of Twice-Yearly Denosumab on Prevention of Bone Mineral Density Loss in De Novo Kidney Transplant Recipients: A Randomized Controlled Trial","volume":"16","author":"Bonani","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3389\/fendo.2018.00162","article-title":"Osteoporosis Therapy with Denosumab in Organ Transplant Recipients","volume":"9","author":"Brunova","year":"2018","journal-title":"Front. Endocrinol."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Alfieri, C., Binda, V., Malvica, S., Cresseri, D., Campise, M., Gandolfo, M.T., Regalia, A., Mattinzoli, D., Armelloni, S., and Favi, E. (2021). Bone Effect and Safety of One-Year Denosumab Therapy in a Cohort of Renal Transplanted Patients: An Observational Monocentric Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091989"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis","volume":"361","author":"Cummings","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1002\/jbmr.403","article-title":"Effects of denosumab on fracture and bone mineral density by level of kidney function","volume":"26","author":"Jamal","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.transproceed.2023.03.017","article-title":"Adverse Effects of Denosumab in Kidney Transplant Recipients: A 20-Year Retrospective Single-Center Observation Study in Central Taiwan","volume":"55","author":"Tsai","year":"2023","journal-title":"Transplant. Proc."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Anastasilakis, A.D., Makras, P., Yavropoulou, M.P., Tabacco, G., Naciu, A.M., and Palermo, A. (2021). Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10010152"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1056\/NEJM200105103441904","article-title":"Effect of Parathyroid Hormone (1-34) on Fractures and Bone Mineral Density in Postmenopausal Women with Osteoporosis","volume":"344","author":"Neer","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00198-006-0189-8","article-title":"Teriparatide in postmenopausal women with osteoporosis and mild or moderate renal impairment","volume":"18","author":"Miller","year":"2007","journal-title":"Osteoporos. Int."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"952","DOI":"10.2215\/CJN.10390917","article-title":"Parathyroidectomy in the Management of Secondary Hyperparathyroidism","volume":"13","author":"Lau","year":"2018","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_91","first-page":"e36248","article-title":"Effects of Cinacalcet on Post-transplantation Hypercalcemia and Hyperparathyroidism in Adult Kidney Transplant Patients: A Single-Center Experience","volume":"15","author":"Alpay","year":"2023","journal-title":"Cureus"},{"key":"ref_92","first-page":"287","article-title":"Long-Term Use of Cinacalcet in Kidney Transplant Recipients with Hyper-calcemic Secondary Hyperparathyroidism: A Single-Center Prospective Study","volume":"16","author":"Zavvos","year":"2018","journal-title":"Exp. Clin. Transplant."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1111\/ajt.12911","article-title":"A randomized study evaluating cinacalcet to treat hypercalcemia in renal transplant recipients with persistent hyperparathyroidism","volume":"14","author":"Evenepoel","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"4860","DOI":"10.1210\/jc.2009-1472","article-title":"Cinacalcet treatment of primary hyperparathyroidism: Biochemical and bone densitometric outcomes in a five-year study","volume":"94","author":"Peacock","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.trre.2010.01.001","article-title":"Treatment with calcimimetics in kidney transplantation","volume":"24","author":"Morales","year":"2010","journal-title":"Transplant. Rev."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/3\/1859\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:54:22Z","timestamp":1760104462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/3\/1859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,3]]},"references-count":95,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["ijms25031859"],"URL":"https:\/\/doi.org\/10.3390\/ijms25031859","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,3]]}}}