Skeletal complications are responsible for significant morbidity and, because of increased survival times, are becoming more prevalent. Osteopenia and osteonecrosis can occur due to immobility, poor nutritional status, decreased muscle mass, steroid use, and immunosuppressive drugs. The first 3 to 6 months posttransplant are accompanied by accelerated bone loss (mostly trabecular). Fractures are common in the first year postoperatively, particularly at sites of trabecular bone (vertebrae and ribs), although long bone and pelvic fractures are also seen. The incidence of vertebral compression fracture may be as high as 38 percent. Patients may develop avascular necrosis of the femoral head from steroid use. Fractures should be treated in the standard fashion.
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