Endocrine Abstracts

Objective: Osteoporosis is a typical long-term complication after solid organ transplantation. Patients after simultaneous pancreas kidney transplantation (SPK) are at a very high risk due to preceding renal osteopathy and diabetic status. To determine the best preventive strategy we analysed the bone metabolism at the point of the pretransplant examination.

Design and methods: In years 2011–2014 the number of 112 patients with type 1 diabetes (69 men, 43 women) entered the waiting list for the SPK for the first time. The mean age was 40.71±10.44 years, duration of diabetes 24.69±7.98 years. The hemodialysis or peritoneal dialysis was alredy established in 40 patients, 72 patients had renal impairement in stage CKD 3-4. We analysed biochemical results and the bone densitometry from their pretransplant investigation.

Results: The mean serum total calcium level was 2.23±0.16 mmol/l, phosphorus 1.67±0.36 mmol/l and intact parathormone 19.05±13.32 pmol/l. The mean 25-hydroxycholecalciferol level was 15.39±7.67 μg/l; 24% patients had vitamine D deficiency. The average lumbal spine T score was −0.94±1.38 with significantly worse results in men than women (−1.19±1.23 vs −0.54±1.46; P=0.015). The average proximal femur T score was −1.39±1.12; comparable between men and women but significantly worse than lumbal spine (P<0.001). Osteoporosis was diagnosed in 22.5% and osteopenia in 50.5% patients, only 27% had normal bone density. The incidence of osteoporosis and osteopenia was similar between men and women.

Conclusions: Patients with type 1 diabetes in CKD 3-5 suffer from serious bone mineral density impairment despite their young age. On contrast to population data the incidence of low bone density is the same among men and women. Bone metabolism should be monitored since early stages of diabetic nephropathy and adequate preventive measures should be introduced.