Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?

I agree with Dr. @Dr. First Last. Bone metabolism in renal transplant is woefully shy of good data. My opinion is to monitor Vitamin D levels, provide appropriate supplementation, and monitor PTH levels, using cinacalcet as needed. My target level for PTH is 1-2x the upper limit of normal, also based on limited data. The other issue about osteopenia is the use of such agents as denosumab or bisphosphonate, where again the data is not clear. The question asked was about repeat scanning in the setting of known osteopenia. In response to that question, I would not necessarily repeat the scan at the one year mark in the absence of fractures. This also begs the question about steroids as there is some knee jerk response to try and stop the stero...

In the absence of good evidence to guide us on what to do in this instance (or good evidence to support different treatments for osteopenia/osteoporosis post-transplant), I would focus on maintaining adequate 25-OH vitamin D levels, keep PTH in a range that I would be comfortable with (arbitrarily <150) and encourage physical activity. I would not re-order the DEXA scan.