When people get a new kidney through transplant, their bones often get healthier. Researchers looked at 179 people who received kidney transplants over 9 years and found that important bone-related chemicals in their blood improved significantly within just 3 months after surgery. These improvements continued to get better or stay stable for up to 2 years. The study also found that patients’ energy levels (measured by hemoglobin) improved too. Importantly, none of the patients in this study broke bones after their transplant, which is good news since kidney disease usually makes bones weaker and more likely to break.

The Quick Take

  • What they studied: Whether kidney transplants help fix bone and mineral problems that develop when kidneys fail
  • Who participated: 179 people (average age 41, mostly men) who received kidney transplants between 2015 and 2023 at a major hospital in Malaysia. Most had been on dialysis for about 18 months before getting their new kidney.
  • Key finding: Within 3 months of transplant, patients’ parathyroid hormone levels and calcium improved significantly. These improvements continued for at least 2 years. No patients broke bones during the study period, which is better than expected for this group.
  • What it means for you: If you’re getting or have gotten a kidney transplant, your bones may start healing within months. However, this study only tracked people for 2 years, so longer-term effects aren’t yet known. Talk to your doctor about bone health monitoring after transplant.

The Research Details

This was a retrospective cohort study, which means researchers looked back at medical records from 179 people who had kidney transplants between 2015 and 2023. They collected information about each patient’s bone-related blood tests, medications, and health measurements before the transplant and at regular intervals afterward (3 months, 1 year, and 2 years). They used computer software to analyze all this data and look for patterns in how patients’ bone health changed over time.

The researchers excluded people who didn’t have complete blood test information at the start or whose new kidney stopped working within the first year. This helped them focus on people whose transplants were successful and who had complete medical records to study.

Looking back at actual patient records (rather than doing a brand-new experiment) is a practical way to understand what really happens to people after kidney transplants. This approach is especially useful for studying long-term effects because researchers don’t have to wait years to collect new data. The 9-year timeframe gave them enough patients and enough time to see meaningful changes in bone health.

This study has several strengths: it included a reasonable number of patients (179), tracked them for a long time (up to 2 years post-transplant), and used standardized blood tests to measure bone health. However, it was done at a single hospital in Malaysia, so results might be slightly different in other countries or populations. The study didn’t have a comparison group of people who didn’t get transplants, which would have made the findings even stronger. Also, researchers couldn’t control for all factors that might affect bone health, like exercise or diet.

What the Results Show

The most important finding was that bone-related chemicals in the blood improved dramatically after transplant. Parathyroid hormone (a chemical that controls bone health) dropped significantly, and calcium levels rose to normal—both of these changes happened within 3 months and stayed improved for 2 years.

Phosphate levels (another important bone mineral) also improved, but this took longer—it continued getting better throughout the 2-year period. Hemoglobin (which carries oxygen in blood and was low in kidney disease patients) also improved steadily over 2 years.

A striking finding was that zero patients broke bones during the entire study period. This is important because people with kidney disease typically have weak bones and break them more easily than healthy people. The fact that no fractures occurred suggests the transplant was protecting their bones.

Most patients stayed on low doses of steroid medication (a median of 5 mg of prednisolone daily) after transplant, which is standard practice to prevent rejection. Only 4 patients needed surgery to remove their parathyroid glands (2 before and 2 after transplant), suggesting most people’s parathyroid glands recovered naturally.

The study found that 19% of patients received ‘pre-emptive’ transplants, meaning they got a new kidney before needing dialysis. These patients may have had slightly different bone profiles, though the study didn’t analyze this separately. Before transplant, most patients were taking multiple medications to manage bone health (calcium supplements, vitamin D medications, and phosphate binders), but these could be adjusted after transplant as their kidneys started working again.

Previous research has shown that kidney disease causes serious bone problems because damaged kidneys can’t regulate calcium, phosphate, and parathyroid hormone properly. This study confirms what doctors expected: that a working transplanted kidney fixes these problems. The improvement happening within 3 months is faster than some previous studies suggested, which is encouraging. The zero fracture rate is notably better than historical data for kidney transplant patients, though this could be due to better medications or care practices now.

This study only followed patients for 2 years, so we don’t know if bone health continues improving or if problems develop later. The study was done at one hospital in Malaysia, so results might differ in other countries with different populations or medical practices. Researchers couldn’t randomly assign people to get or not get transplants (that would be unethical), so they couldn’t compare transplant patients to a control group. The study didn’t measure bone density directly (using special X-rays), only blood chemicals, so we don’t know if actual bone strength improved. Finally, the study didn’t track lifestyle factors like exercise or diet that could affect bone health.

The Bottom Line

If you’re receiving or have received a kidney transplant: (1) Expect your bone-related blood tests to improve within 3 months—this is a good sign your new kidney is working. (2) Continue taking all prescribed medications, including steroids and any bone health medications, as directed. (3) Ask your doctor about bone density screening, especially if you’re older or have other risk factors for weak bones. (4) Maintain a healthy lifestyle with adequate calcium and vitamin D intake, weight-bearing exercise, and no smoking. Confidence level: Moderate to High for the blood test improvements; Lower for long-term fracture prevention since this study only covered 2 years.

This research is most relevant for: people who have received or are planning to receive kidney transplants, their family members, and healthcare providers managing transplant patients. It’s particularly important for people who had severe bone problems from kidney disease. This study is less relevant for people with healthy kidneys or those still on dialysis (though it shows what they might expect after transplant). People with other types of bone disease should discuss how these findings apply to their specific situation with their doctor.

You should expect to see improvements in blood test results within 3 months of transplant. Most improvements continue through the first 2 years. However, bone density (actual bone strength) may take longer to improve, and this study didn’t measure that. Full recovery of bone health might take several years, and some people may need ongoing monitoring or treatment. Talk to your transplant team about a bone health monitoring schedule.

Want to Apply This Research?

  • Track your parathyroid hormone (PTH), calcium, and phosphate levels at 3 months, 6 months, 1 year, and 2 years post-transplant. Record the dates and values in your app to see your personal improvement trend. Also note any bone pain, muscle weakness, or falls.
  • Set reminders to take all bone health medications (calcium, vitamin D, phosphate binders) as prescribed. Log daily calcium intake (target: 1000-1200 mg) through food or supplements. Track weight-bearing exercise (walking, strength training) at least 3 times weekly. Record any fractures, falls, or bone-related symptoms immediately.
  • Create a quarterly check-in reminder to review your latest lab results with your transplant team. Set up a ‘bone health dashboard’ showing your PTH, calcium, and phosphate trends over time. Track medication adherence weekly. Schedule annual bone density screening (DEXA scan) starting 1-2 years post-transplant, especially if you’re over 50 or have risk factors for osteoporosis.

This research describes what happened in one hospital’s kidney transplant patients and should not replace personalized medical advice from your transplant team. Individual results vary significantly based on age, overall health, medications, and other factors. The study only tracked patients for 2 years, so long-term effects beyond this period are unknown. If you have concerns about your bone health after kidney transplant, fracture risk, or any symptoms like bone pain or muscle weakness, consult your nephrologist or transplant surgeon immediately. This information is educational and not a substitute for professional medical diagnosis or treatment.