Sunday, August 30, 2009

Post Transplant Watch: Bone Disease

Bone disease is something that kidney disease often brings with it. The reason for this is that our kidneys play a major role in building our bones and keeping them strong.

One other issue is steroids. Most kidney transplant centers have used steroids as part of their immunosuppression protocols. Over the years, great strides in the post kidney transplant medication management have allowed doctors to minimize the doses of steroids we have to take in order to keep our transplants. In fact, there a already a number of transplant centers that have moved to a steroid-free immunosuppression protocol with great success rates.

But for most of us, whose transplant centers regimens include steroids, and for those who require steroids otherwise experience rejection, the consequences of steroids is something we have to deal with.

Here are some steps that doctors will monitor closely in order to minimize the problems caused by steroids with respect to bone disease.

RISK FOR OSTEOPEROSIS

Osteopenia and osteoperosis are two situations that everyone looks to avoid. They are signs that our bones are weaker that should be and in many cases more brittle and thinner also. Having weaker bones makes us more susceptible to fractures and other bone injuries as well as unwanted changes in our stature that make it more difficult to function normally.

For patients at risk of osteoperosis, the following guidelines will help in preventing it from happening and keep a close watch so that more aggressive treatment can be made when there are possible signs of moving towards it.

Being in any of following situations may put you in greater risk of osteoperosis

  • Women
  • Menopause or above 45 years
  • Personal or family history of low-trauma fractures
  • Amenorrhoea (absence of menstrual bleeding)
  • Slender build (BMI <>
STEP 1: Weight bearing exercises
I learned that weight bearing exercises are very important in keeping our bones strong. They also help build bone density. The logic sounds contrary to what we'd normally think. Common thinking would be, by not pushing or handling weight, we preserve our bones. But ironically, forcing our bones against heavier objects and making them 'work', actually improves their health, similar to how our muscles react to exercise. While being sedentary makes our bones deteriorate faster.

Not all exercises, however, are created equal. Some help in increasing bone mass and strength, while others don't. For example, exercises like lifting weights, brisk walking, climbing stairs strengthen bones, while swimming, rowing, cycling have been shown not to be as effective.

Also, different exercises affect different bones. Activities like climbing stairs, jumping and brisk walking help increase bone density in the hips and spine, whereas push-ups, for example, strengthen the bones in with wrist, arms and shoulders.
STEP 2: If you smoke, stop
Studies have shown that smoking is detrimental to bone health and bone healing.

The reason? Cigarettes and tobacco contain nicotine, which constricts blood vessels of their normal diameter. Because of the constriction of the vessels, the amount of nutrients that are supplied to the bones are less than they should be.
STEP 3:Calcium carbonate
Taking calcium carbonate is often needed in order to make sure that you get sufficient calcium that may otherwise be lacking from diet.
STEP 4:Vitamin D if or other activated forms of Vitamin D
Along with calcium, vitamin D is needed in order to build bones. With lessened function, the kidney isn't able to produce the same amount of vitamin D that it used to. Thus, supplementation with vitamin D is often required.

Depending on how well kidney function is, however, the type of vitamin D matters. If kidney function is good, meaning a GFR of 50ml/min or higher, then the vitamin D3 supplements are often given.

But in cases where there is decreased kidney function, like when creatinine is above 200 ╬╝mol/L or 2.3 mg/dL, your doctor may prescribe an activated form of vitamin D formulation like, alfacalcidol.

In doing this, it effectively side steps the need for the kidney to work in order to convert the vitamin D that comes in oral form or sunlight into the activated form which is what the body can use.
STEP 5: DEXA scan
A DEXA scan can be compared to other imaging machines like x-rays, and MRI machines. What they do is to scan through our bones and provide us an indication of how strong our bones are, in terms of bone mass density.

This is something that isn't always done by physicians but something I've learned to be quite important in gauging how well our bones have done over time (if they are improving or weakening) and if the current treatments being prescribed are working.

It is a good idea to get one before transplantation and yearly thereafter for comparison.
In an upcoming post, we will take a look at how the steps may differ when a diagnosis of osteopenia or osteoperosis has been determined.

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2 comments:

  1. Great info. The use of prednisone is heavy on one's bones and having your bone density checked is a must even if you're one a low dose.

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