TOPLINE:

A nationwide registry-based study found that 1 in 5 kidney transplant recipients experienced fractures within 10 years post-transplant, with the risk remaining stable over two decades despite advances in treatment. Among those who sustained a fracture, 28% had at least one subsequent fracture, with the highest risk seen at 6-12 months after the initial event.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using Danish health registries to assess the risk, prognosis, and management of fractures in 3977 adults (median age at transplantation, 50 years; 37% women) who underwent a first single-organ kidney transplant between 2000 and 2022.
• Most centres employed induction and maintenance glucocorticoids as standard of care; however, one centre followed a steroid-free protocol after induction throughout the study period.
• The 5- and 10-year cumulative incidences of any post-transplant fracture were calculated, treating death as a competing risk; both crude and sex- and age-standardised incidence rates of fractures were estimated across different time periods.
• Incident fractures were defined as the first fracture occurring after transplantation; subsequent fractures were those occurring after a fracture-free interval of 30 days (different sites) or 90 days (same site).

TAKEAWAY:

• During the median follow-up of 6.2 years, 788 (20%) patients sustained a first post-transplant fracture, with most fractures occurring in the peripheral skeleton. The 5- and 10-year cumulative incidences of any first post-transplant fracture were 12.9% and 21.2%, respectively.
• Crude incidence rates of fractures remained unchanged over two decades, whereas age- and sex-standardised incidence rates showed a slight decline.
• Patients transplanted under a corticosteroid-free standard protocol had a lower risk for fracture than those transplanted under a corticosteroid-containing protocol (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.67-0.94).
• The risk for mortality was significantly elevated after fracture, especially after a hip fracture (aHR, 2.69; 95% CI, 2.04-3.56); overall, 220 (28%) patients had at least one subsequent fracture after a first post-transplant fracture, with the highest risk occurring at 6-12 months after the initial event.

IN PRACTICE:

"This study demonstrates that fracture risk remains a major challenge in kidney transplant recipients even under steroid minimization protocols. We emphasize the continued disease burden caused by bone fragility and the overlooked risk of subsequent fracture following a first event," the authors wrote.

SOURCE:

This study was led by Ina Karstoft Ystrøm, Aarhus University, Aarhus, Denmark. It was published online on February 06, 2026, in Clinical Kidney Journal.

LIMITATIONS:

The retrospective design and the lack of individual-level data on targeted therapy, immunosuppressive therapy (including corticosteroids), bone density results, fracture risk profile, and fracture trauma mechanisms may have limited the study's findings. Many vertebral fractures were likely underreported due to their asymptomatic nature. Additionally, the findings may not be generalisable to other ethnic groups as the cohort was predominantly of European descent.

DISCLOSURES:

This study received financial support from the Health Research Foundation of the Central Denmark Region, the Danish Society of Nephrology's Research Foundation, Nyreforeningens Forskningsfond, and other sources. One author reported receiving lecture fees from UCB and travel support from UCB and Abiogen Pharma, unrelated to the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.