Effect of cyclical intravenous clodronate therapy on bone mineral density and markers of bone turnover in patients receiving home parenteral nutrition.
BACKGROUND
Patients receiving home parenteral nutrition (HPN) because of intestinal failure are at high risk of developing osteoporosis.


OBJECTIVE
We studied the effect of the bisphosphonate clodronate on bone mineral density (BMD) and markers of bone turnover in HPN patients.


METHODS
A 12-mo, double-blind, randomized, placebo-controlled trial was conducted to study the effect of 1500 mg clodronate, given intravenously every 3 mo for 1 y, in 20 HPN patients with a bone mass T score of the hip or lumbar spine of less than -1. The main outcome measure was the difference in the mean percentage change in the BMD of the lumbar spine measured by dual-energy X-ray absorptiometry. Secondary outcome measures included changes in the BMD of the hip, forearm, and total body and biochemical markers of bone turnover, ie, serum osteocalcin, urinary pyridinoline, and urinary deoxypyridinoline.


RESULTS
The mean (+/-SEM) BMD of the lumbar spine increased by 0.8 +/- 2.0% in the clodronate group and decreased by 1.6 +/- 2.0% in the placebo group (P = 0.43). At all secondary skeletal sites (ie, hip, total body, and distal forearm), we observed no changes or small increases in the BMD of the clodronate group and decreases in the BMD of the placebo group. In the clodronate group, biochemical markers of bone resorption decreased significantly (P < 0.05).


CONCLUSIONS
Clodronate significantly inhibits bone resorption as assessed by changes in biochemical markers of bone turnover. Although the mean BMD increased in the clodronate group, cyclic clodronate therapy failed to increase spinal BMD significantly at 12 mo.
Haderslev
Kent V
KV
Department of Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. khaderslev@dadlnet.dk
Tjellesen
Lone
L
Sorensen
Henrik A
HA
Staun
Michael
M
D000328:Adult; D000963:Antimetabolites / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects*; D001862:Bone Resorption / Q000517:prevention & control*; D004002:Clodronic Acid / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010024:Osteoporosis / Q000517:prevention & control*; D010281:Parathyroid Hormone / Q000097:blood; D016331:Parenteral Nutrition, Home; D017698:Postmenopause; D017697:Premenopause; D012016:Reference Values
D000963:Antimetabolites; D010281:Parathyroid Hormone; D004002:Clodronic Acid