High risk of osteoporosis and fracture following solid organ transplantation: a population-based study

Hsin Chen; Yung-Rung Lai; Yih Yang; Shuo-Yan Gau; Cheng-Yang Huang; Tung-Han Tsai; Kuang-Hua Huang; Chien-Ying Lee

doi:10.3389/fendo.2023.1167574

High risk of osteoporosis and fracture following solid organ transplantation: a population-based study

Front Endocrinol (Lausanne). 2023 May 23:14:1167574. doi: 10.3389/fendo.2023.1167574. eCollection 2023.

Authors

Hsin Chen^{1

2}, Yung-Rung Lai^{3

4}, Yih Yang⁵, Shuo-Yan Gau¹, Cheng-Yang Huang¹, Tung-Han Tsai⁶, Kuang-Hua Huang⁶, Chien-Ying Lee^{3

4}

Affiliations

¹ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
² Department of Medical Education, Linkou Chang-Gung Memorial Hospital, Taoyuan City, Taiwan.
³ Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.
⁴ Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
⁶ Department of Health Services Administration, China Medical University, Taichung, Taiwan.

Abstract

Background: Osteoporosis and fractures increase morbidity and mortality rates after solid organ transplantation (SOT), but few studies have analyzed the risk of osteoporosis and related fractures after SOT. In this retrospective cohort study, we investigated the risk of osteoporosis and fractures in different SOT recipients.

Methods: This study was a retrospective cohort study using a nationally representative database in Taiwan. We collected the data of SOT recipients and used the propensity score matching method to obtain a comparison cohort. To reduce bias, we excluded patients who had been diagnosed with osteoporosis or fracture before inclusion. All participants were followed up until the date of diagnosis as having a pathological fracture, death, or the end of 2018, whichever occurred first. The Cox proportional hazards model was used to investigate the risk of osteoporosis and pathological fracture in SOT recipients.

Results: After adjustment for the aforementioned variables, SOT recipients were observed to have a higher risk of osteoporosis (hazard ratio (HR) = 1.46, 95% confidence interval (CI): 1.29-1.65) and fracture (HR: 1.19, 95% CI: 1.01-1.39) than the general individuals. Among the different SOT recipients, the highest risk of fractures was noted in heart or lung transplant recipients, with a HR of 4.62 (95% CI: 2.05-10.44). Among the age groups, patients aged >61 years had the highest HRs for osteoporosis (HR: 11.51; 95% CI, 9.10-14.56) and fracture (HR: 11.75, 95% CI: 8.97-15.40).

Conclusion: SOT recipients had a higher risk of osteoporosis and related fractures than the general population, with the highest risks observed in patients receiving heart or lung transplants, older patients, and patients with CCI scores of >3.

Keywords: cohort study; fracture; hazard ratios; osteoporosis; solid organ transplantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Fractures, Bone* / epidemiology
Fractures, Bone* / etiology
Fractures, Spontaneous* / etiology
Humans
Organ Transplantation* / adverse effects
Osteoporosis* / epidemiology
Osteoporosis* / etiology
Retrospective Studies

Grants and funding

This research was supported by the Chung Shan Medical University Hospital, Taiwan (CSH-2023-C-002), the China Medical University, Taiwan (CMU111-MF-111), and the National Science and Technology Council, Taiwan (MOST 110-2410-H-040-002).