Discordance Between Fracture Risk and Bone Health Management After Kidney Transplantation: A Nationwide Cohort Study
Ji Eun Kim, Chan Mi Park, Seung Min Song, Min Woo Kang, Hyo Jin Kim, Eun Jung Cho, Gang Jee Ko, Young Joo KwonABSTRACT
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.