Abstract: Background and objectives The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 <15 ng/ml) was more common in female recipients at CKD-T stages I?III (29.6% vs 44.4%; p = 0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p = 0.01). Vertebral fractures (VFx) with deformity grade ?2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01?1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6?6.3); in females, age (OR 1.07; 95% CI: 1.03?1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043?1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

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