Prevention of osteoporosis in heart transplant recipients: a comparison of calcitriol with calcitonin and pamidronate.
Bone loss and osteoporotic fractures are common in cardiac transplant recipients. To compare two prophylactic medical regimens after heart transplantation, 26 consecutive heart transplant recipients were randomized to receive either continuous oral calcitriol (0.5 microg/day) combined with nasal salmon calcitonin (200 U/day) for the first 3 months (group A) or intermittent intravenous pamidronate (0.5 mg/kg body weight) every third month (group B). Bone mineral density (BMD) and biochemical indices of bone turnover were measured at baseline and 3, 6, 12, and 18 months after transplantation. The mean pretransplant BMD, measured by dual energy X-ray absorptiometry (DXA) was significantly lower in the patients compared with age-matched healthy controls. During the first year of treatment, rates of bone loss at the lumbar spine and femoral neck were slightly but significantly slower in the patients treated with pamidronate, but there was no longer a significant difference between the two groups after 18 months of heart transplantation. Irrespective of the mode of osteoporosis prevention, osteocalcin levels increased whereas urinary deoxypyridinoline decreased after transplantation, and significant bone loss was observed in both treatment groups. We found no relationship between initial BMD, markers of bone turnover, cumulative glucocorticoid dose, or cyclosporine levels and the rate of bone loss after cardiac transplantation. In summary, we found that the rapid and severe bone loss following heart transplantation could be attenuated by two preventive measures, pamidronate or calcitriol with calcitonin.
Division of Endocrinology and Diabetes, University Hospital, Zürich, Switzerland.
T
T
Bianda
A
A
Linka
G
G
Junga
H
H
Brunner
H
H
Steinert
W
W
Kiowski
C
C
Schmid
D015502:Absorptiometry, Photon; D000281:Administration, Intranasal; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000652:urine; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000378:metabolism; D002116:Calcitonin / Q000627:therapeutic use*; D002117:Calcitriol / Q000627:therapeutic use*; D002118:Calcium / Q000652:urine; D002120:Calcium Channel Agonists / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005269:Femur; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010024:Osteoporosis / Q000097:blood / Q000517:prevention & control* / Q000652:urine; D000077268:Pamidronate
D000596:Amino Acids; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D002120:Calcium Channel Agonists; D004164:Diphosphonates; D015675:Osteocalcin; C036020:deoxypyridinoline; D002116:Calcitonin; D002117:Calcitriol; D000077268:Pamidronate; D002118:Calcium