This study aims to evaluate BMD and bone biomarkers and to investigate the effects of immunosuppressives on bone disease after RTx. Thirty-three RTR aged 16.7 +/- 3.7yr and healthy controls (n=32) were enrolled. There was no difference between pre-RTx BMD and BMD at the time of study (45.9 +/- 30.9months after RTx), while both values were lower than controls (p<0.01 and p<0.05, respectively). Worst BMD scores were obtained at sixth month after RTx (-0.2 +/- 0.9) and best at fourth year (1.4 +/- 1.3). 25-hydroxy-(OH) vitamin D and OPG were higher in RTR (p<0.001). BMD z scores negatively correlated with OPG and cumulative CS doses at the time of study (r=-0.344, p<0.05 and r=-0.371, p<0.05, respectively). Regression analysis revealed OPG as the only predictor of BMD ( -0.78, 95% CI -0.004 to -0.013, p<0.001). The increase in OPG, a significant predictor of BMD, could either be secondary to graft dysfunction or for protection against bone loss. CS doses should be minimized to avoid their untoward effects on bone metabolism.