Fracturing osteoporosis after kidney transplantation--what are the options?

The patient who receives a renal graft does not have virgin bones. Renal transplantation must be performed in a patient with pre-existing bone disease, i.e. renal osteodystrophy, characterized by secondary hyperparathyroidism, calcitriol deficiency, phosphate retention, metabolic acidosis and possibly aluminium accumulation. These pathomechanisms are further modulated by factors such as duration of dialysis, type of dialysis, diet, control of serum phosphate, use phosphate-binding agents etc.