Lumbar bone mineral density in renal transplant patients on neoral and tacrolimus: a four-year prospective study.
BACKGROUND
This prospective study was designed to investigate the long-term evolution of bone mineral density (BMD) in kidney transplant recipients.


METHODS
In 86 patients with functioning grafts, 65 on tacrolimus-based immunosuppression and 21 on cyclosporine-based immunosuppression, laboratory parameters and BMD measurements in lumbar spine (L2-L4) and femoral neck (FN) were performed by DEXA in the first month after transplantation (baseline) and yearly thereafter up to the fourth year.


RESULTS
BMD did not change at 12 months in lumbar spine nor in the FN. Detailed analysis identified three patterns of BMD in lumbar spine at 12 months: BMD remained stable in 27 patients (31.4%), decreased >2% in 31 (36.0%) and increased >2% in 28 (32.6%). Patients with no change or gain presented a parallel increase of BMD in FN (P<0.001 in both groups). On multivariate analysis, the variables associated with no change or lumbar BMD loss were total prednisone dose in grams at 12 months (OR 1.402; 95% CI 1.038-1.893; P=0.028), calcitriol levels at 12 months (OR 0.936; 95% CI 0.892-0.982; P=0.007) and lumbar BMD at baseline (OR 1.006; 95% CI 1.002-1.010; P=0.002). Late treatment with calcium supplements and calcitriol did not improve osteopenia.


CONCLUSIONS
One third of patients had bone loss mainly during the first year of follow-up. Bone loss was associated to higher baseline BMD, high steroid dose, and lower calcitriol levels at 1 year. Late administration of calcitriol and calcium supplements did not improve posttransplant osteopenia. More than 50% of patients were osteopenic 4 years after transplantation.
Department of Nephrology, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Ctra. Colmenar Viejo km. 9,1, 28034 Madrid, Spain. rmarcen.hrc@salud.madrid.org
Roberto
R
Marcén
Carmen
C
Caballero
Julio
J
Pascual
José Luis
JL
Teruel
Maite
M
Tenorio
Javier
J
Ocaña
Juan José
JJ
Villafruela
Francisco Javier
FJ
Burgos
Ana María
AM
Fernández
Alfonso
A
Muriel
Joaquín
J
Ortuño
D000328:Adult; D000368:Aged; D015519:Bone Density; D002117:Calcitriol / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005272:Femur Neck; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D016572:Cyclosporine; D002117:Calcitriol; D016559:Tacrolimus