Effects of a single infusion of pamidronate prior to liver transplantation: a bone histomorphometric study.
Osteoporosis is a common and serious complication of solid organ transplantation. Effective therapeutic regimens have not been established but evidence that increased bone turnover is responsible for bone loss early after transplantation provides a rationale for the use of anti-resorptive agents in the peri-operative period. We have examined the effects of a single pre-operative infusion of pamidronate, 60 mg, on bone remodelling and turnover in a prospective study of 12 patients, four male and eight female aged 19-61 years, with chronic liver disease, who formed a subgroup of a larger randomised controlled single-blind study. Iliac-crest biopsies were obtained before and 3 months after liver transplantation and histomorphometry performed using image analysis. In untreated patients ( n=5) a significant increase in bone formation rate at tissue level was demonstrated at 3 months in comparison to pre-operative values (0.035+/-0.013 vs. 0.161+/-0.12 microm(2)/microm/day; mean +/- SD, P=0.003). In patients treated with pamidronate ( n=7) no significant increase in bone formation rate was demonstrated at 3 months, although there was a trend towards an increase in indices of bone turnover. In this group there was also a significant reduction in erosion cavity length (210.4+/-63.8 vs. 179.8+/-67.5 microm; P=0.03) and non-significant reductions in other indices of erosion cavity size. These results indicate that pre-operative administration of pamidronate in patients with chronic liver disease prevents, at least in part, the increase in bone turnover which occurs in untreated patients after transplantation.
Vedi
Shobna
S
Department of Medicine, Box 157, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge CB2 2QQ, UK.
Ninkovic
Mary
M
Garrahan
Nigel J
NJ
Alexander
Graeme J M
GJ
Compston
Juliet E
JE
D000328:Adult; D016723:Bone Remodeling / Q000187:drug effects*; D001862:Bone Resorption / Q000517:prevention & control; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control*; D000077268:Pamidronate; D011446:Prospective Studies; D016037:Single-Blind Method
D004164:Diphosphonates; D000077268:Pamidronate