Osteoporosis and Fractures After Solid Organ Transplantation: A Nationwide Population-Based Cohort Study

Objective: To investigate the incidence of bone disorders after solid organ transplantation (SOT). Participants and Methods: We used Taiwan's National Health Insurance Research Database to identify 9428 recipients of SOT and 38,140 sex-and age-matched control subjects between January 1, 1997, and December 31, 2010, to compare the incidence and risk of bone disorders between groups. Results: Recipients of SOT had a significantly higher incidence of osteoporosis and related fractures compared with the non-SOT group. The overall hazard ratio (HR) of osteoporosis after SOT was 5.14 (95% CI, 3.13-8.43), and the HR of related fractures was 5.76 (95% CI, 3.80-8.74). The highest HRs were observed in male patients (HR, 7.09; 95% CI, 3.09-16.3) and in those aged 50 years or younger (HR, 7.38; 95% CI, 2.46-22.1). In addition, SOT patients without any comorbidities had a 9.03-fold higher risk of osteoporosis than non-SOT participants (HR, 9.03; 95% CI, 5.29-15.4). To compare the risk of osteoporosis and related fractures in different recipients of SOT, the highest risk of osteoporosis and fractures was noted in patients receiving lung transplantation, followed by other types of SOT. Conclusion: We report high rates of metabolic bone disorders after SOT in chronic transplant patients over a long follow-up. Both underlying bone disorders before transplantation and use of immunosuppressant agents may contribute to bone disorders after transplantation.