title: Bisphosphonates and bone fractures in long-term kidney transplant recipients.
abstract: BACKGROUND
  There is little information on the role of bisphosphonates and bone mineral density (BMD) measurements for the follow-up and management of bone loss and fractures in long-term kidney transplant recipients.
  
  
  METHODS
  To address this question, we retrospectively studied 554 patients who had two BMD measurements after the first year posttransplant and compared outcomes in patients treated, or not with bisphosphonates between the two BMD assessments. Kaplan-Meier survival and stepwise Cox regression analyses were performed to examine fracture-free survival rates and the risk-factors associated with fractures.
  
  
  RESULTS
  The average time (+/-SE) between transplant and the first BMD was 1.2+/-0.05 years. The time interval between the two BMD measurements was 2.5+/-0.05 years. There were 239 and 315 patients in the no-bisphosphonate and bisphosphonate groups, respectively. Treatment was associated with significant preservation of bone loss at the femoral neck (HR 1.56, 95% CI 1.21-2.06, P=0.0007). However, there was no association between bone loss at the femoral neck and fractures regardless of bisphosphonate therapy. Stepwise Cox regression analyses showed that type-1 diabetes, baseline femoral neck T-score, interleukin-2 receptor blockade, and proteinuria (HR 2.02, 0.69, 0.4, 1.23 respectively, P<0.01), but not bisphosphonates, were associated with the risk of fracture.
  
  
  CONCLUSIONS
  Bisphosphonates may prevent bone loss in long-term kidney transplant recipients. However, these data suggest a limited role for the initiation of therapy after the first posttransplant year to prevent fractures.
authors.affiliation: Department of Medicine, University of Wisconsin Madison, Madison, WI, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Conley
authors.forename: Brenda
authors.initials: B
authors.lastname: Muth
authors.forename: Millie
authors.initials: M
authors.lastname: Samaniego
authors.forename: Mary
authors.initials: M
authors.lastname: Lotfi
authors.forename: Barbara
authors.initials: B
authors.lastname: Voss
authors.forename: Mike
authors.initials: M
authors.lastname: Armbrust
authors.forename: John
authors.initials: J
authors.lastname: Pirsch
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000209:etiology; D001842:Bone and Bones / Q000187:drug effects*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004164:Diphosphonates