Current Status of Research on Osteoporosis after Solid Organ Transplantation: Pathogenesis and Management

Table 1

Effects of immunosuppressive agents on skeleton.

Immunosuppressive drugs	Effects on skeleton
Glucocorticoids
Direct effects	Inhibit bone formation
	Stimulate bone resorption
Indirect effect on skeleton	Reduce intestinal calcium absorption
	Increase urinary calcium excretion
	Decrease growth hormone secretion
	Decrease gonadal secretion of estrogen and androgens
Calcineurin inhibitors
Cyclosporine A and tacrolimus	High-turnover osteopenia with resorption exceeding formation
Sirolimus and everolimus	Inhibit bone resorption
Mycophenolate mofetil	No effect on bone volume
Azathioprine	No effect on bone volume
Mizoribine	Unknown

These observations are based primarily on animal studies.