Osteoporosis after cardiac transplantation.
OBJECTIVE
The purpose of this study was to determine the prevalence of osteopenia and fractures and to describe the biochemical indices of mineral metabolism in patients who have undergone cardiac transplantation.


METHODS
Forty adult patients who had received a cardiac transplant between 1982 and 1990 and who were receiving immunosuppressive therapy with prednisone and cyclosporine A were studied. Bone densitometric measurements by dual-energy x-ray absorptiometry of the lumbar spine and femoral neck and radiographs of the thoracic and lumbar spine were obtained for all patients. Routine serum and urine biochemical values as well as more specialized biochemical analyses (intact parathyroid hormone, metabolites of vitamin D, and osteocalcin) were obtained.


RESULTS
Osteopenia was present in 28% of the patients at the lumbar spine and 20% of the patients at the femoral neck. Vertebral fractures were present in 35% of patients. In contrast to other patients receiving glucocorticoids, serum osteocalcin, a marker of bone formation, was elevated in 60% of patients.


CONCLUSIONS
Osteopenia and vertebral fractures are common in patients after cardiac transplantation. The presence of elevated osteocalcin levels suggests that the pathogenesis of the osteoporosis in these patients differs from that of glucocorticoid-induced osteoporosis.
Shane
E
E
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
Rivas
M C
MC
Silverberg
S J
SJ
Kim
T S
TS
Staron
R B
RB
Bilezikian
J P
JP
D015502:Absorptiometry, Photon; D015519:Bone Density; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000378:metabolism; D016027:Heart Transplantation; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D011241:Prednisone / Q000627:therapeutic use; D015995:Prevalence; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism
D016572:Cyclosporine; D011241:Prednisone