title: Resistance exercise training and alendronate reverse glucocorticoid-induced osteoporosis in heart transplant recipients.
abstract: BACKGROUND
  Immunosuppression therapy with bolus glucocorticoids causes regional osteoporosis in the axial skeleton of heart transplant recipients (HTR). No preventive strategy is generally accepted for steroid-induced bone loss.
  
  
  METHODS
  To determine the efficacy of an anti-osteoporosis regimen that combined a bisphosphonate agent (alendronate sodium) with the osteogenic stimulus of mechanical loading, 25 HTRs were randomly assigned either to a group that received alendronate (10 mg/day) for 6 months (ALEN; n = 8), a group that received alendronate (10 mg/day) and performed specific resistance exercises for 6 months (ALEN + TRN; n = 8) or to a non-intervention control group (CONTR; n = 9). Alendronate was initiated at 2 months after transplantation. Bone mineral density (BMD) of the total body, femur neck and lumbar spine (L-2 and L-3) was measured by dual-energy X-ray absorptiometry before and 2, 5 and 8 months after transplantation. Resistance training consisted of lumbar extension exercise (MedX) performed 1 day/week and 8 variable resistance exercises (MedX) performed 2 days/week.
  
  
  RESULTS
  Pre-transplantation BMD values did not differ among the 3 groups. BMD of the total body, femur neck and lumbar vertebra were significantly decreased below baseline at 2 months after transplantation in CONTR (-2.6 +/- 0.9%, -5.1 +/- 1.8%, -12.5 +/- 4.2%, respectively), ALEN (-2.8 +/- 0.8%, -5.3 +/- 1.6%, -12.0 +/- 3.9%) and ALEN + TRN groups (-2.7 +/- 1.0%, -5.6 +/- 2.1%, -11.2 +/- 3.7%). CONTR had further significant losses of BMD after 3 and 6 months. ALEN had no further regional BMD losses after initiation of alendronate therapy. ALEN + TRN restored BMD of the whole body, femur neck and lumbar vertebra to within 0.9%, 2.1%, and 3.4% of pre-transplantation levels, respectively.
  
  
  CONCLUSIONS
  Resistance exercise plus alendronate was more efficacious than alendronate alone in restoring BMD in HTRs. Our results indicate that anti-osteoporosis therapy in this population should include both an anti-resorptive agent as well as an osteogenic stimulus, such as mechanical loading.
authors.affiliation: Center for Exercise Science, College of Health and Human Performance, University of Florida, PO Box 118206, Gainesville, FL 32611, USA. rbraith@hhp.ufl.edu
authors.forename: Randy W
authors.initials: RW
authors.lastname: Braith
authors.forename: Peter M
authors.initials: PM
authors.lastname: Magyari
authors.forename: Michael N
authors.initials: MN
authors.lastname: Fulton
authors.forename: Juan
authors.initials: J
authors.lastname: Aranda
authors.forename: Tracy
authors.initials: T
authors.lastname: Walker
authors.forename: James A
authors.initials: JA
authors.lastname: Hill
mesh_terms: D019386:Alendronate / Q000627:therapeutic use*; D015519:Bone Density; D005081:Exercise Therapy; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019386:Alendronate