Unexpected low incidence of vertebral fractures in heart transplant recipients: analysis of bone turnover.
Heart transplantation (HTX) is associated with a reduction in bone mineral density (BMD). Different markers of bone metabolism have been used, and the applied immunosuppressive regimens have also changed over time. This study was performed to re-investigate bone metabolism in HTX recipients. Twenty-five HTX recipients were compared with 25 HTX candidates in respect of biochemical parameters of bone metabolism, BMD, and the frequency of fractures for 1 year. Osteopenia or osteoporosis was observed in approximately two-thirds of the HTX recipients. Nevertheless, only three (12%) HTX recipients developed a vertebral fracture within 1 year after transplantation; no peripheral fractures occurred. Compared with HTX candidates, HTX recipients had lower serum levels of osteocalcin, and higher serum levels of cross-linked-N-telopeptide of type I collagen (NTX). In HTX recipients, osteocalcin initially reached a nadir, increased during the first 3 months, and decreased thereafter. Bone-specific alkaline phosphatase initially increased and then decreased. Serum levels of NTX and parathyroid hormone remained high throughout the year. Despite a high bone turnover, an unexpectedly low rate of vertebral fractures was registered. Nevertheless, each fragility fracture is a serious complication and we need to take steps to prevent this complication.
Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria. Katharina.Kerschan-Schindl@meduniwien.ac.at
Katharina
K
Kerschan-Schindl
Margot
M
Ruzicka
Stephane
S
Mahr
Matthias
M
Paireder
Christian
C
Krestan
Andreas
A
Gleiss
Christian
C
Bieglmayer
Veronika
V
Fialka-Moser
Richard
R
Pacher
Michael
M
Grimm
Peter
P
Pietschmann
D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology*
D015675:Osteocalcin