Elsevier S & T

Bone Disease of Organ Transplantation

Compston, Juliet; Shane, Elizabeth

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Table of contents

Copyright Pageiv
Contentsv
Prefacexvii
Contributorsxix
Part I: Basic Transplantation and Bone Biology1
Chapter 1. Principles of Transplantation Immunology3
I. Immunological Mechanisms3
II. Immunosuppressants8
III. Rejection Management15
References23
Chapter 2. Bone Biology: Bone Structure and Remodeling31
I. Introduction31
II. Bone Structure31
III. Bone Remodeling32
IV. Systemic Regulators of Bone Growth and Remodeling36
V. Local Regulators of Bone Remodeling39
VI. Conclusion40
References41
Chapter 3. Skeletal Effects of Glucocorticoids: Basic and Clinical Aspects47
I. Introduction47
II. Mechanisms of Glucocorticoid Action in Bone47
III. Clinical Aspects of Glucocorticoid-Induced Osteoporosis51
IV. Management of Glucocorticoid-Induced Osteoporosis53
References56
Chapter 4. Transplantation Bone Disease Induced by Non-Steroid Immunosuppressants61
I. Introduction61
II. Calcineurin Inhibitors62
III. Mechanisms62
IV. Therapeutic Considerations65
V. Clinical Studies Supporting the Role of Calcineurin Inhibitors in Bone Loss after Transplantation67
VI. Other Immune-Modifying Drugs68
VII. Cancer Therapies and Hypogonadism71
VIII. Conclusion72
References72
Chapter 5. Molecular Effects of Calcineurin Inhibitors79
I. Introduction79
II. Cyclosporin A80
III. FK50681
IV. Mechanism of Bone Loss with Calcineurin Inhibition83
V. Rapamycin85
VI. Summary86
References86
Chapter 6. Bone and the Immune System91
I. Introduction91
II. Cells and Cytokines That Regulate Osteoclast Formation92
III. Mechanism of Action of Estrogen in Bone94
IV. T Cell–Produced Cytokines and Bone Loss95
V. Mechanisms of Estrogen Regulation of T-cell Production of TNF97
VI. Estrogen Regulation of IFNγ Production and in Vivo Effects of IFNγ in Bone100
VII. The Role of IL-7 in PTBD and Postmenopausal Bone Loss101
VIII. Conclusions102
References103
Part II: Pathogenesis of Transplantation-Related Bone Disease111
Chapter 7. Fracture Prevalence and Incidence in Solid Organ Transplant Recipients113
I. Introduction113
II. Liver Transplantation115
III. Cardiac Transplantation136
IV. Lung Transplantation139
V. Kidney Transplantation142
VI. Kidney–Pancreas Transplantation149
VII. Summary and Conclusions149
References151
Chapter 8. Bone Histomorphometry and Its Application to Transplantation Bone Disease159
I. Introduction159
II. Pathophysiology of Bone Loss after Transplantation160
III. Histomorphometric Assessment of Bone Remodelling and Structure162
IV. Bone Histomorphometric Analysis of Transplantation Bone Disease164
References169
Chapter 9. The Role of Parathyroid Hormone in the Evolution of Bone Loss after Organ Transplantation173
I. Introduction173
II. Isolated Glucocorticoid Use and PTH174
III. Isolated Calcineurin Inhibitor Use and PTH177
IV. Transplant-Induced Osteoporosis and PTH: Dynamic Evidence178
V. Transplant-Induced Osteoporosis and PTH: Densitometric Evidence181
VI. Transplant-Induced Osteoporosis and PTH: Histomorphometric Evidence182
VII. Bone Formation Recovery: Is There a Role for PTH?184
VIII. Conclusion185
References186
Chapter 10. The Role of Hypogonadism in the Evolution of Bone Loss before and after Cardiac Transpla193
I. Introduction193
II. The Role of Calcineurin-Phosphatase Inhibitors in Regulation of Gonadal Hormones194
III. The Effects of Glucocorticoids on Gonadal Hormones196
IV. The Effect of Antiproliferative Agents on Gonadal Hormones197
V. Clinical Features of Hypogonadism after Cardiac Transplantation198
VI. Clinical Features of Hypogonadism before Cardiac Transplantation200
VII. Prevention and Management of Hypogonadism201
References203
Chapter 11. Pathogenesis of Transplantation Bone Disease: A Unifying Hypothesis209
I. Introduction209
II. A Proposed Model209
III. Evidence for the Proposed Model210
IV. Implications of the Model for Treatment214
V. Summary215
References215
Part III: Clinical Features of Transplantation Bone Disease219
Chapter 12. Bone Disease after Kidney Transplantation221
I. Introduction221
II. Terminology221
III. Substrate:The Chronic Kidney Disease Patient at the Time of Transplantation223
IV. Post-Transplant Bone Diseases224
V. Management229
References237
Chapter 13. Histologic Abnormalities of Bone before and after Kidney Transplantation243
I. Pretransplant Bone Disease244
II. Post–Kidney Transplant Bone Disease246
References250
Chapter 14. Bone Disease Following Kidney–Pancreas and Pancreas Transplantation255
I. Introduction255
II. Fractures Following Transplantation256
III. Bone Mineral Density257
IV. Bone Biomarkers258
V. Bone Histology259
VI. Pathophysiology259
VII. Evaluation for Post-Transplant Bone Disease262
VIII. Management of Bone Disease262
IX. Summary and Conclusions264
References265
Chapter 15. Bone Disease after Liver Transplantation271
I. Introduction271
II. Post-Transplantation Bone Loss271
III. Fractures after Liver Transplantation273
IV. Biochemical and Hormonal Parameters273
V. Histomorphometric Data275
VI. Risk Factors for Fractures and Bone Loss276
VII. Pathogenesis of Bone Disease after Liver Transplantation278
VIII. Treatment279
References282
Chapter 16. Bone Disease in Patients before and after Cardiac Transplantation287
I. Introduction287
II. Bone Disease prior to Cardiac Transplantation287
III. Bone Disease after Cardiac Transplantation289
IV. Management of Osteoporosis in Recipients of Cardiac294
V. Conclusions298
References298
Chapter 17. Bone Loss in Patients before and after Lung Transplantation303
I. Introduction303
II. Bone Disease in Patients with End-Stage Pulmonary Disease303
III. Osteoporosis in Patients after Lung Transplantation307
IV. Prevention and Treatment of Osteoporosis in Patients with Chronic Lung Disease309
V. Prevention and Treatment of Osteoporosis in Patients after Lung Transplantation311
VI. Conclusions315
References316
Chapter 18. Transplantation for Cystic Fibrosis: Effect on the Skeleton319
I. Introduction319
II. Description and Pathophysiology of Bone Disease in Cystic Fibrosis320
III. Clinical Manifestations of Low Bone Mineral Density in Cystic Fibrosis Patients326
IV. Therapy for Low Bone Mineral Density in Cystic Fibrosis Patients before Lung Transplantation327
V. Lung Transplantation for Cystic Fibrosis Patients330
VI. Conclusions333
References334
Chapter 19 Bone Disease after Bone Marrow Transplantation339
I. Introduction339
II. Candidates for Bone Marrow Transplantation339
III. Bone Loss after Bone Marrow Transplant340
IV. Bone Marrow Transplantation341
V. Prevention and Management of Osteoporosis after Bone Marrow Transplant345
VI. Summary348
References348
Chapter 20. Osteonecrosis and Organ Transplantation353
I. Introduction353
II. Clinical Features of Osteonecrosis353
III. Osteonecrosis and Organ Transplantation354
IV. Pathophysiology of Osteonecrosis357
V. Diagnosis of Osteonecrosis359
VI. Natural History of Osteonecrosis361
VII. Management of Osteonecrosis363
VIII. Conclusion366
References366
Chapter 21. Pediatric Transplant Bone Disease373
I. Introduction373
II. Epidemiology of Solid–Organ Transplantation in Children374
III. Impact of the Underlying Primary Disease on Bone376
IV. Threats to Bone Health Following Transplantation380
V. Assessment of Bone Status in Children and Adolescents383
VI. Clinical Studies of Bone Health in Pediatric Transplant Recipients386
VII. Potential Therapies for Bone Health in Transplant Recipients390
VIII. Summary393
References394
Part IV: Management403
Chapter 22. Management of Bone Disease in Candidates for Organ Transplant405
I. Introduction405
II. Assessment of Bone Health That Applies to All Transplant Candidates406
III. General Measures to Improve Bone Strength408
IV. Heart or Lung Transplant Candidates417
V. Liver Transplant Candidates419
VI. Renal Osteodystrophy428
VII. Summary434
References434
Chapter 23. Management: Prevention of Bone Loss after Organ Transplantation447
I. Introduction447
II. Vitamin D448
III. Bisphosphonates451
IV. Combinations of Bisphosphonates and Vitamin D455
V. Other Therapies and Approaches456
VI. Summary457
References458
Chapter 24. Management: Established Osteoporosis in Organ Transplant Recipients461
I. Introduction461
II. Fracture Risk Assessment463
III. Nonpharmacological Interventions466
IV. Pharmacological Interventions466
References478
Index483

Book details

Vendor Elsevier S & T
SKU 9780121835026
ISBN-13 9780080490540
Author Compston, Juliet; Shane, Elizabeth
Category Medical
Subject Rheumatology

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Bone disease, particularly osteoporosis, has emerged as a common and serious complication of solid organ transplantation. In recent years there have been real advances in our understanding of the pathogenesis and pathophysiology of bone loss, however treatment studies have been relatively sparse and successful strategies to reduce skeletal morbidity after transplantation remain to be clearly established. This book provides a unique resource for the many health professionals involved with transplantation of bone disease, both in terms of its scientific background and the management of the disease in clinical practice.

Contents:
-Basic Transplantation and Bone Biology
-Pathogenesis of Transplantation Related Bone Disease
-Clinical Features of Transplantation Bone Disease
-Management

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