Bone mineral density in lung-transplant recipients before and after graft: prevention of lumbar spine post-transplantation-accelerated bone loss by pamidronate.
BACKGROUND
Lung-transplant recipients are at risk of osteoporosis. They may have low bone mass even before posttransplantation immunosuppressive therapy. We studied bone mineral density (BMD) before and after lung transplantation and compared the efficacy of antiresorptive therapies to calcium and vitamin D supplementation.


METHODS
Areal BMD was assessed in 42 patients awaiting lung transplantation and measured again after surgery at 6 (n = 29), and at 12 months (n = 20). Nineteen patients received antiresorptive therapy (30 mg pamidronate IV every 3 months (n = 14), or hormonal replacement therapy (n = 5)), and 10 patients received only calcium and vitamin D supplements.


RESULTS
Mean age- and gender-adjusted lumbar spine (LS) and femoral neck (FN) BMD was significantly decreased prior to transplantation (- 0.6 +/- 0.2, p< 0.01, and - 1.5 +/- 0.2 standard deviation, p < 0.001, respectively). At that time, 29% were osteoporotic (T-score < - 2.5 below the peak bone mass), while 55% were below - 1.0 T-score. Antiresorptive therapy decreased the rate of LS bone loss during the first 6 months and led to a significant increase of BMD at 1 year, with LS changes of + 0.2 +/- 0.1 vs - 0.4 +/- 0.1 Z-score in the calcium-vitamin D group (p< 0.002), and + 0.2 +/- 0.1 vs - 0.04 +/- 0.1 for FN (NS). One out of 20 patients experienced clinically evident fractures during antiresorptive therapy, and 3 out of 12 in the calcium-vitamin D group.


CONCLUSIONS
A significant proportion of patients awaiting lung transplantation was osteoporotic or osteopenic. Antiresorptive therapy (pamidronate or hormone-replacement therapy (HRT)) prevented accelerated LS bone loss after graft.
Trombetti
A
A
Division of Bone Diseases,a WHO Collaborating Center for Osteoporosis and Bone Diseases, University Hospital of Geneva, Switzerland.
Gerbase
M W
MW
Spiliopoulos
A
A
Slosman
D O
DO
Nicod
L P
LP
Rizzoli
R
R
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001862:Bone Resorption / Q000517:prevention & control*; D002118:Calcium / Q000008:administration & dosage; D019587:Dietary Supplements; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control*; D000077268:Pamidronate; D011183:Postoperative Complications; D013122:Spinal Diseases / Q000517:prevention & control*; D014807:Vitamin D / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D014807:Vitamin D; D000077268:Pamidronate; D002118:Calcium