title: Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation.
abstract: BACKGROUND
  Early, rapid bone loss and fractures after cardiac transplantation are well-documented complications of steroid administration; therefore, we undertook this study on the effects of long-term calcitonin on steroid-induced osteoporosis.
  
  
  METHODS
  Twenty-three heart transplant recipients on maintenance immunosuppression with cyclosporine, mycophenolate mofetil and prednisone were retrospectively studied. All patients received long-term prophylactic treatment with elemental calcium and vitamin D. Twelve (52.2%) patients also received long-term intranasal salmon calcitonin, whereas 11 (47.8%) received none. Bone mineral density and vertebral fractures were assessed at yearly intervals. Statistical comparisons between each group's bone loss during the first year and in the early (1 to 3 years), intermediate (4 to 6 years) and late (7+ years) post-transplantation periods were done.
  
  
  RESULTS
  Lumbar spine bone loss was significant during the early follow-up period in the group not receiving calcitonin (0.744 +/- 0.114 g/cm(2) vs 0.978 +/- 0.094 g/cm(2) [p = 0.002]). The calcitonin group showed bone mineral density (BMD) levels within normal average values throughout the study period. BMD increased in the no-calcitonin group during the intermediate (4 to 6 years) and late (7+ years) follow-up periods, with values approaching normal average and no significant difference between the 2 groups (0.988 +/- 0.184 g/cm(2) vs 0.982 +/- 0.088 g/cm(2) [p = 0.944] and 0.89 +/- 0.09 g/cm(2) vs 1.048 +/- 0.239 g/cm(2) [p = 0.474], respectively).
  
  
  CONCLUSIONS
  Prophylactic treatment with intranasal salmon calcitonin prevents rapid bone loss associated with high-dose steroids early after cardiac transplantation. Long-term administration does not seem warranted in re-establishing BMD.
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA.
authors.forename: Emmanouil I
authors.initials: EI
authors.lastname: Kapetanakis
authors.forename: Athanassios S
authors.initials: AS
authors.lastname: Antonopoulos
authors.forename: Theofani A
authors.initials: TA
authors.lastname: Antoniou
authors.forename: Kassiani A
authors.initials: KA
authors.lastname: Theodoraki
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Zarkalis
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sfirakis
authors.forename: Despina A
authors.initials: DA
authors.lastname: Chilidou
authors.forename: Peter A
authors.initials: PA
authors.lastname: Alivizatos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption / Q000139:chemically induced / Q000517:prevention & control; D002116:Calcitonin / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D036361:Peptide Hormones / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D036361:Peptide Hormones; D002116:Calcitonin