Discordance Between Fracture Risk and Bone Health Management After Kidney Transplantation: A Nationwide Cohort Study.

BACKGROUND

Bone loss and fractures are critical post-kidney transplantation (KT) complications. We evaluated age-stratified screening practices, treatment patterns, and fracture incidence in a nationwide KT cohort.

METHODS

Using the Korean National Health Insurance Service database (2003-2020), we analyzed 34 758 adult KT recipients. Screening practices (bone mineral density [BMD] testing), medication continuity, and incident fractures were assessed across age groups (< 50, 50-64, ≥ 65 years).

RESULTS

During a median follow-up of 8.4 years, 63.8% of recipients underwent BMD testing, but only 29.9% were screened within the first year post-transplant. Overall fracture incidence was 1.2/100 person-years (PY), increasing to 3.9/100 PY in recipients aged ≥ 65 (IRR 5.41 vs. < 50 years). The excess fracture risk in older recipients persisted across all post-transplant time intervals (adjusted SHR 4.18, 4.23, and 3.61 for < 1, 1-5, and ≥ 5 years, respectively). Despite a 5.2- to 7.6-fold increase in post-KT fracture risk associated with a pre-transplant fracture history, screening practices were not consistently intensified among younger patients with prior fractures.

CONCLUSIONS

Post-transplant bone health management is characterized by delayed assessment and insufficient risk-stratified screening. Risk-adapted strategies are necessary to improve early screening and sustained therapy, particularly for high-risk recipients.