Mechanisms of rapid bone loss following cardiac transplantation

Sambrook, P N; Pj, Kelly; Fontana, Dario; Nguyen, T.V.; Keogh, Anne; Macdonald, P.; Spratt, Phillip; Freund, Judith; Eisman, JA

doi:10.1007/bf01623351

Cited by 90 publications

(62 citation statements)

References 15 publications

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“…Figure 4 shows the bone loss from the spine of first-time user followed in longitudinal studies [9,20,25,33,38,42,51,56,67,71]. One limitation of evaluating bone loss longitudinally is that daily dose may vary and reduce over time.…”

Section: Onset Of Skeletal Effectsmentioning

confidence: 99%

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Staa

Leufkens

Cooper

2002

Osteoporosis International

1,038

272

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Abstract. Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

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Section: Onset Of Skeletal Effectsmentioning

confidence: 99%

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Staa

Leufkens

Cooper

2002

Osteoporosis International

1,038

272

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“…Sambrook et al (15) suggested that bone loss after cardiac transplantation is related to hypogonadism due to the initial high doses of corticosteroids that these patients receive immediately after surgery. These authors observed decreased serum levels of testosterone immediately after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors observed higher levels of bone resorption markers and decreases in serum testosterone and osteocalcin immediately after transplantation (14,24). Sambrook et al (15) even suggested that osteocalcin could be used as a predictive measurement of bone loss in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Sambrook et al (15) have suggested that bone loss posttransplantation is due to a combination of accelerated turnover and hypogonadism. Thus, we investigated bone mass in heart transplant and in chronic heart failure (CHF) patients waiting for transplantation; furthermore, we evaluated the status and biochemical markers of bone resorption in these groups of patients.…”

Section: Introductionmentioning

confidence: 99%

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Reduced bone mineral density in men after heart transplantation

Anijar¹,

Szejnfeld²,

Almeida

et al. 1999

Braz J Med Biol Res

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Heart transplantation is associated with rapid bone loss and an increased prevalence and incidence of fractures. The aim of the present study was to compare the bone mineral density (BMD) of 30 heart transplant (HT) recipients to that of 31 chronic heart failure (CHF) patients waiting for transplantation and to determine their biochemical markers of bone resorption and hormone levels. The BMD of lumbar spine and proximal femur was determined by dual-energy X-ray absorptiometry. Anteroposterior and lateral radiographs of the thoracic and lumbar spine were also obtained. The mean age of the two groups did not differ significantly. Mean time of transplantation was 25.4 ± 21.1 months (6 to 88 months). Except for the albumin levels, which were significantly higher, and magnesium levels, which were significantly lower in HT patients when compared to CHF patients, all other biochemical parameters and hormone levels were within the normal range and similar in the two groups. Both groups had lower BMD of the spine and proximal femur compared to young healthy adults. However, the mean BMD of HT patients was significantly lower than in CHF patients at all sites studied. Bone mass did not correlate with time after transplantation or cumulative dose of cyclosporine A. There was a negative correlation between BMD and the cumulative dose of prednisone. These data suggest that bone loss occurs in HT patients mainly due to the use of corticosteroids and that in 30% of the patients it can be present before transplantation. It seems that cyclosporine A may also play a role in this loss. Correspondence

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“…A exposição a maiores doses de glicocorticóides, menores concentrações de vitamina D, maiores níveis séricos de marcadores de reabsorção óssea e, no homem, concentração de testosterona reduzida, associam-se a maior perda óssea. Pelo menos até o 6º mês do transplante, os níveis séricos de 1,25(OH)D3, de osteocalcina e de testosterona permanecem reduzidos (35,36).…”

Section: Transplante Cardíacounclassified

Osteoporose após transplante de órgãos sólidos

Cipriani

Farias

2005

Arq Bras Endocrinol Metab

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RESUMOA osteoporose é uma complicação comum após os transplantes de rim, coração, fígado e pulmão. Os esquemas imunossupressores para evitar a rejeição do órgão enxertado após o transplante freqüentemente incluem glicocorticóides, ciclosporina A e tacrolimus, os quais possuem efeitos danosos sobre a homeostase mineral óssea, impostos a um esqueleto já comprometido. Outros fatores que provavelmente contribuem para a patogênese da osteoporose pós-transplante são deficiência de vitamina D, hiperparatireoidismo secundário e hipogonadismo. Medidas para avaliação da saúde óssea antes do transplante deveriam ser realizadas: densitometria mineral óssea, radiografia da coluna, avaliação do nível de vitamina D e dos hormônios gonadais. Todos os pacientes transplantados deveriam ser submetidos à profilaxia da perda óssea. Estudos clínicos sugerem que os bisfosfonatos são os agentes mais promissores para a prevenção e o tratamento da osteoporose pós-transplante. ABSTRACT Osteoporosis After Solid Organs Transplantation.Osteoporosis is a common complication following kidney, heart, liver and lung transplantation. Immununosuppressive regimens to prevent graft rejection after transplantation commonly include glucocorticoids, cyclosporin A and tacrolimus which are detrimental to bone and mineral homeostasis and are superimposed on an already compromised skeleton. Additional factors likely to contribute to post-transplantation osteoporosis pathogenesis are vitamin D insufficiency, secondary hyperparathyroidism and hypogonadism. Measures should be taken to optimize bone health prior transplantation: bone mineral density and spinal Xrays should be performed, and vitamin D and gonadal status assessed. Prophylaxis against bone loss after transplantation should be considered for all patients. Data from clinical trials suggest that bisphosphonates are the most promising agents for the prevention and treatment of post-transplantation osteoporosis. EMBORA A IDÉIA MAIS COMUM seja de que a osteoporose acometa primariamente as mulheres pós-menopausa, outras populações também são de alto risco. Um desses grupos é formado pelos receptores de transplante de órgãos, e quanto maior a sobrevida desses pacientes, maior será o tempo de exposição aos riscos de fraturas. Nas últimas décadas, os transplantes vêm se tornando uma terapia efetiva para doenças renais, hepáticas, cardíacas e pulmonares em estágios finais. O Brasil acompanha essa progressão no número revisão

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Mechanisms of rapid bone loss following cardiac transplantation

Cited by 90 publications

References 15 publications

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Reduced bone mineral density in men after heart transplantation

Osteoporose após transplante de órgãos sólidos

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