Prevention of Bone Loss in Cardiac Transplant Recipients

Abstract

Bone mineral density is already abnormally reduced at the moment of cardiac transplantation and bone loss occurs at an impressive rate in the first postoperative year. The aim of the study was to compare two prophylactic medical regimens as to their efficacy in mitigating bone loss after transplantation. Forty-eight consecutive recipients were randomized to receive either alternating calcium carbonate and disodium etidronate (group A) or a daily supplement of calcium carbonate and alphacalcidol (group B). Bone mineral density measurements were performed immediately before hospital discharge and 6, 12, and 24 months after surgery using dual energy X-ray absorptiometry. Clinical events were recorded and roentgenograms of the spine were performed postoperatively and 1 and 2 years later. In both treatment groups bone loss remained significant at the level of the lumbar spine in the first postoperative year (P<0.005) and at the level of the femoral neck in the first (P<0.005) and the second (P<0.06) year after transplantation. Six months after transplantation, however, patients receiving alphacalcidol had a significant reduction in bone loss at the level of the lumbar spine (P=0.047) and at the level of the femoral neck (P=0.043). At the level of the femoral neck this decrease in bone loss was even more pronounced in the second postoperative year (P<0.001). In the group of patients treated with disodium etidronate, 4 recipients needed additional hospitalizations for treatment of symptomatic fractures at the level of the lumbar spine or the femoral neck. No such events happened in recipients receiving vitamin D supplements. Prophylactic administration of calcium carbonate and alphacalcidol after cardiac transplantation reduces bone loss and seems to decrease osteoporotic complications.

Post-Transplantation Bone Disease

“…Consistently with these findings, our group have found that in patients randomized immediately after cardiac transplantation to 32000 IU/week of oral calcidiol for 18 months, lumbar spine BMD increased 5%, whereas those who received cyclical etidronate or nasal calcitonin, showed decreases in spine BMD (Garcia-Delgado et al, 1997). Also, alfacalcidol therapy has been associated with an increase in BMD or prevention of additional bone loss in renal (El-Agroudy et al, 2003) and cardiac recipients ( Van Cleemput et al, 1996).…”

A prospective study of bone loss and turnover after allogeneic bone marrow transplantation: effect of calcium supplementation with or without calcitonin

“…Additional treatment such as biologically active vitamin D preparations or new effective bisphosphonates require testing in further studies. The former has been of benefit in patients receiving corticosteroid treatment 28 in association with organ transplants 29 and a preliminary report confirms benefits provided by bisphosphonates in organ transplant recipients. 30 …”

Preventing Bone Loss in Renal Transplant Recipients with Vitamin D

“…However, despite the use of lower maintenance doses of corticosteroids, as a result of the use of CsA, a decrease of early posttransplantation bone loss has not been observe as a result of an imbalance in bone remodeling consistent with the toxic effects of steroids (3). In renal transplant recipients, posttransplantation bone loss is more complex (18). Pretransplantation renal osteodystrophy and persistent hyperparathyroidism are still risk factors.…”