Treatment of Osteopenia and Osteoporosis After Kidney Transplantation

Grotz, Wolfgang; Rump, L. C.; Niessen, A; Schmidt‐Gayk, H.; Reichelt, A.; Kirste, Günter; Olschewski, Manfred; Schollmeyer, P.

doi:10.1097/00007890-199810270-00007

Cited by 117 publications

(86 citation statements)

References 13 publications

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“…The study, which includes both men and women, confirms that pamidronate ameliorates bone loss as reported by Fan et al (18) in men alone. Although there was a downward trend noted in the vertebral BMD after the last dose of pamidronate, PAM continued to have significantly higher BMD than did CON.…”

Section: Discussionsupporting

confidence: 88%

“…Both CON and PAM received vitamin D and calcium, which are commonly prescribed in patients who receive long-term steroid therapy for various underlying conditions (3,5,6). Vitamin D and calcium were not given in the previously reported trials of use of bisphosphonates in renal (18,19), possibly accounting for the decrease in hip BMD in their control groups during their study period. In addition, as the hip consists mainly of cortical bone, which has lower remodeling rates than the mainly cancellous bone found in the vertebrae, it may require a longer time of observation before any treatment differences can be detected.…”

Section: Discussionmentioning

confidence: 99%

“…They have been used with varying success in treatment of bone loss associated with cardiac (13,14) and liver transplantation (15)(16)(17). Recent studies have shown favorable effects on BMD in renal transplant recipients (18,19).…”

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confidence: 99%

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Prevention of Bone Loss in Renal Transplant Recipients

Coco¹,

Glicklich²,

Faugère

et al. 2003

Journal of the American Society of Nephrology

233

155

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Abstract. Renal transplant recipients are at risk of developing bone abnormalities that result in bone loss and bone fractures. These are related to underlying renal osteodystrophy, hypophosphatemia, and immunosuppressive treatment regimen. Although bisphosphonates are useful in ameliorating bone mineral loss after transplantation, it is not known whether their use in renal transplant patients leads to excessive suppression of bone turnover and increased incidence of adynamic bone disease. A randomized, prospective, controlled, clinical trial was conducted using the bisphosphonate pamidronate intravenously in patients with new renal transplants. Treatment subjects (PAM) received pamidronate with vitamin D and calcium at baseline and at months 1, 2, 3, and 6. Control (CON) subjects received vitamin D and calcium only. During months 6 to 12, the subjects were observed without pamidronate treatment. Biochemical parameters of bone turnover were obtained monthly and, bone mineral density (BMD) was obtained at baseline and months 6 and 12. Bone biopsies for mineralized bone histology were obtained at baseline and at 6 mo in a subgroup of subjects who underwent scheduled living donor transplantation. PAM preserved bone mass at 6 and 12 mo as measured by bone densitometry and histomorphometry. CON had decreased vertebral BMD at 6 and 12 mo (4.8 Ϯ 0.08 and 6.1 Ϯ 0.09%, respectively). Biochemical parameters of bone turnover were similar in both groups at 6 and 12 mo. Bone histology revealed low turnover bone disease in 50% of the patients at baseline. At 6 mo, all of PAM had adynamic bone disease, whereas 50% of CON continued to have or developed decreased bone turnover. Pamidronate preserved vertebral BMD during treatment and 6 mo after cessation of treatment. Pamidronate treatment was associated with development of adynamic bone histology. Whether an improved BMD with adynamic bone histology is useful in maintaining long-term bone health in renal transplant recipients requires further study.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Prevention of Bone Loss in Renal Transplant Recipients

Coco¹,

Glicklich²,

Faugère

et al. 2003

Journal of the American Society of Nephrology

233

155

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“…Trials using zoledronic acid has also given positive results 55. Calcitonin seems to be ineffective in preventing early bone loss, but may have some benefit in the later post-transplant period in liver56 and renal57 transplant recipients and can be considered a safe alternative if other agents are contraindicated or poorly tolerated.…”

Section: Specific Types Of Osteoporosismentioning

confidence: 99%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

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“…Long-term administration of corticosteroids also is known to be associated with numerous adverse effects that lead to increased patient morbidity and mortality after renal transplantation. The adverse effects of corticosteroids, including new-onset diabetes, hyperlipidemia, hypertension, growth retardation, accelerated bone loss, weight gain, avascular necrosis, cataracts, cosmetic changes, depression, psychotic behavior, and others, have been well documented Hricik et al, 1993;Grotz et al, 1998;Kobashigawa & Kasiske, 1997;Schulak & Hricik, 1994). There also is evidence that they may interfere with the tolerogenic pathways of organ acceptance (Qian et al, 1997;Wang et al, 2001).…”

Section: Interactions Between Glucocorticoids and Tacrolimusmentioning

confidence: 99%