European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.8. Bone disease.

A. All kidney-transplanted patients should undergo a systematic evaluation of their skeletal status, including pre-transplant history of renal osteodystrophy, history of fractures and plasma concentrations of calciotropic hormones and other parameters, and if possible measurement of bone mineral density (BMD). B. Glucocorticoid therapy should be given at the lowest possible dosage. As long as patients are receiving steroids, vitamin D treatment (ergocalciferol or 1,25-dihydroxyvitamin D) is highly recommended. C. Optimal prevention of bone disease by vitamin D treatment, sufficient calcium intake, sex hormone substitution and appropriate use of thiazide diuretics should be considered in all transplant patients. D. In established osteopenia, bisphosphonate treatment should be considered despite limited information in transplant recipients. E. Persistent tertiary hyperparathyroidism should be observed for 1 year after transplantation whenever possible to allow for a spontaneous involution. F. In patients with GFR <50 ml/min after transplantation, uraemic osteodystrophy should be prevented.