Parathyroidectomy Protects Against Pathologic Fractures After Kidney Transplantation: Results From a Retrospective Single-center Trial

Kidney transplant (KTx) recipients are a high-risk population for pathologic fractures. We herein aim to identify modifiable factors associated with pathological fractures and bone disease in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data was extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis including medication were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Pathologic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx, fracture incidence of 10 per 1000 person-years). Prior to KTx, (subtotal) parathyroidectomy (PTX) was performed in 116 patients (16.3%) (median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n= 47), only one (2.2%) patient was parathyroidectomized. After adjusting for known fracture risk factors for MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018 – 0.991, p=0.049). We observe a reduced risk for pathological fractures in parathyroidectomized KTx patients independent from elevated parathyroid hormone at the time of KTx or afterwards.