Incidence of Skeletal Complications in Renal Graft Recipients:Effect of Changes in Pharmacotherapy

The purpose of this study was to examine whether the occurrence of skeletal complications of renal transplantation is affected by a reduction in the steroid dose and avoidance of hypophosphataemia after the operation. A group of 36 patients that had been given smaller steroid doses and where non-phosphate-binding antacid had been given to most of the patients with hypophosphataemia were compared with a group of 144 long-term survivors given the formerly used, higher dose of steroids, and also phosphate-binding antacid agents. The modification of the regimen did not reduce the incidence of spontaneous fractures but none of the patients developed osteonecrosis after this change (P less than 0.1). Patients in the group receiving non-phosphate-binding antacids displayed a higher serum phosphorus level (P less than 0.1). Our results suggest that the development of osteonecrosis after renal transplantation may be avoided by reducing the steroid dose and avoiding hypophosphataemia.