Effect of long-term calcitonin administration on steroid-induced osteoporosis after cardiac transplantation.
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.
Kapetanakis
Emmanouil I
EI
Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA.
Antonopoulos
Athanassios S
AS
Antoniou
Theofani A
TA
Theodoraki
Kassiani A
KA
Zarkalis
Dimitrios A
DA
Sfirakis
Peter D
PD
Chilidou
Despina A
DA
Alivizatos
Peter A
PA
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
D000305:Adrenal Cortex Hormones; D036361:Peptide Hormones; D002116:Calcitonin