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TRANSPLANTATION

Use of Bone Health Protocol to Identify and Prevent Bone Disease in Kidney and Pancreas Transplant Recipients

Clinical Pharmacy Specialist, Medical University of South Carolina, Charleston, SC

Elizabeth A Ashcraft, PharmD

Clinical Pharmacy Specialist, Medical University of South Carolina

G Mark Baillie, PharmD

Clinical Pharmacy Specialist, Medical University of South Carolina

D Bart Lawrence, PharmD

Medical Science Liaison, Pfizer Global Pharmaceuticals, New York, NY

Kenneth D Chavin, MD PhD

Associate Professor of Surgery, Department of Surgery, Division of Transplant, Medical University of South Carolina

Prabhakar K Baliga, MD

Director, Division of Transplant Surgery; Professor of Surgery, Department of Surgery, Division of Transplant, Medical University of South Carolina

Reprints: Dr. Taber, Department of Pharmacy Services, Medical University of South Carolina, 150 Ashley Ave., Charleston, SC 29425, fax 843/792-5166, taberd{at}musc.edu

BACKGROUND: Posttransplant bone disease is a well recognized and undertreated problem. The use of protocols within other populations has been shown to improve recognition and treatment of common disease states, but outcome studies involving the use of protocols within transplant patients are lacking.

OBJECTIVE: To compare the appropriate screening for and the prevention and treatment of osteopenia and osteoporosis in transplant patients before and after a bone health protocol was implemented.

METHODS: A retrospective analysis in a single institution was designed to determine whether the development and implementation of a comprehensive bone health protocol impacted disease outcomes in posttransplant kidney and simultaneous kidney–pancreas patients.

RESULTS: There were 132 patients in the historical control group and 76 in the treatment group. The groups were well matched, with no statistically significant differences noted for any of the baseline characteristics that were compared, including the modifiable and nonmodifiable risk factors known to put a patient at increased risk for osteopenia or osteoporosis. Significantly more patients in the treatment group received proper screening and prevention compared with the historical control group (p < 0.001). Although more patients in the treatment group received proper bone disease treatment, this did not reach statistical significance (81% vs 66%; p < 0.22). Additionally, the dual energy X-ray absorptiometry scans were performed, on average, 19 days earlier in the treatment group, although this also did not achieve statistical significance (p = 0.149).

CONCLUSIONS: The multidisciplinary development and implementation of a comprehensive bone health protocol improves the screening and prevention of osteopenia and osteoporosis within kidney and pancreas transplant recipients.

Key Words: bone health, osteopenia, osteoporosis, transplantation

Published Online, April 24, 2007. www.theannals.com, DOI 10.1345/aph.1K039