after transplantation usually patients are on immunosupprrssants like glucocoticoids,azathioprim ,cyclosporins atc and further if there is any associated disturbance in thyroid function it is known to get affected by the preexisting kidney disease and affects calcium and phosphorus metabolism so taking every factor into consideration one should replace vit D ,calcium supplementation and if a postmenopausal lady give hormonal replacement therapy th decrease the dditive factors affecting bone turnover or tibolone ,besides sunlight and correct thyroid function apropriately and bisphosphnates have to be individualized and since most of pts undergoing transplantation are elderly ones one has to look into the underlying pathology which was responsible for renal transplantation ,maybe poor diabetic control etc and control all metabolic parameters.

This is a big problem in post-transplantation patients. The renal osteodystrophy (secondary hyperparathyroidism because of the chronic kidney failure) existing before transplantation may not be influenced positively by the transplantation. On the other hand the osteoporosis may be aggravated by the adminstration of glucocorticoids. In my opinion a complex treatment is needed. There should be attempted to reduce progressively the glucocorticoid dosage, and the eventual application of  immunosuppressive medication other than corticosteroids seems to be reasonable. Otherwise, vitamin D3 active metabolites and biphosphonates should be routinely used. 

To add to the previous answers, it is a cmplex issue indeed. The current approaches to PMO may not have similar antifracture effectiveness. Vitamin D supplementation to maintain plasma levels above 30 ng/dl should be a must. Maybe the carreful addition of and active D metabolite might add some benefit. Serum iPTH however shold be followed at certain intervals to be sure it is not suppressed. Antiresorptive therapy (bisphosphonates and maybe denosumab) might be beneficial in certain patients, but there is still the question of how much suppression of bone remodelling is feasible in these subjects.