Bone health in living kidney donors

PURPOSE OF REVIEW: Living kidney donors may experience changes in bone mineral metabolism, which adversely affect the skeletal system. In this review, we summarize the literature assessing the relationship between living kidney donation, changes in bone mineral metabolism, and skeletal fracture. RECENT FINDINGS: Living kidney donor nephrectomy may lower the concentration of 1,25-dihydroxyvitamin D and phosphate and raise the concentration of parathyroid hormone, with no appreciable effect on the concentration of calcium. There is conflicting evidence on whether the concentration of fibroblast growth factor 23 rises after kidney donation. Whether these changes in bone mineral metabolism alter skeletal fracture risk in living kidney donors is an open question. To date, a single study of over 2000 living kidney donors (median age 43 years) matched to a segment of the general population selected for good health has found that after a median follow-up of 6.6 years (maximum 17.7 years), the rate of fragility (osteoporotic) fractures is no higher in donors compared to nondonors. SUMMARY: Living kidney donors experience changes in bone mineral metabolism. Long-term studies are needed to determine whether an association between living kidney donation and fracture exists.