Prevalence and treatment of decreased bone density in renal transplant recipients: a randomized prospective trial of calcitriol versus alendronate.
BACKGROUND
Reduced bone mineral density (BMD) is common in long-term renal transplant recipients and results in a high incidence of fractures. The optimal therapy for these patients is not known.


METHODS
Baseline BMD determinations were obtained in 211 long-term adult renal transplant recipients. One hundred and seventeen patients with a reduced BMD (T score < or = -1) were randomly assigned to treatment with alendronate and calcium (n=60) versus calcitriol and calcium (n=57). Of these, 46 and 51 patients, respectively, completed 1 year of treatment. Forty-nine patients who were not eligible or did not consent to the trial were followed prospectively.


RESULTS
Reduced baseline BMD (T score < or = -1) was present in 159 (78.7%) of patients at the lumbar spine or femur. There was no significant loss of BMD in the prospectively followed patients during 2.7 years. The average lumbar BMD increased from 0.984+/-0.149 to 1.025+/-0.143 g/cm2 (P<0.001) with alendronate and from 1.014+/-0.15 to 1.034+/-0.146 g/cm2 (P=0.002) with calcitriol. BMD at the femur increased from 0.809+/-0.092 to 0.836+/-0.107 g/cm2 (P<0.001) with alendronate and from 0.830+/-0.144 to 0.857+/-0.125 g/cm2 (P=0.023) with calcitriol.


CONCLUSIONS
One year of treatment with alendronate or calcitriol, both with calcium supplementation, resulted in significant increases in BMD at the lumbar spine and femur, with a trend toward alendronate being more effective at the spine (P=0.082). Further studies are needed to determine whether BMDs continue to increase after 1 year and whether there is any additional benefit to combining vitamin D and alendronate. Larger studies are needed to determine whether treatment decreases fracture rates.
Jeffery
John R
JR
Department of Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada. JJeffery@hsc.mb.ca
Leslie
William D
WD
Karpinski
Martin E
ME
Nickerson
Peter W
PW
Rush
David N
DN
D000328:Adult; D019386:Alendronate / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001862:Bone Resorption / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D002117:Calcitriol / Q000627:therapeutic use*; D002120:Calcium Channel Agonists / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use
D002120:Calcium Channel Agonists; D016572:Cyclosporine; D002117:Calcitriol; D009173:Mycophenolic Acid; D001379:Azathioprine; D011241:Prednisone; D019386:Alendronate