The effect of low-dose cholecalciferol and calcium treatment on posttransplant bone loss in renal transplant patients: a prospective study.
OBJECTIVE
Posttransplant steroid doses have been reduced with the use of new and potent immunosuppressive agents. However, posttransplant osteoporosis is still a serious problem. Our aim in this study was to investigate the effect of low-dose cholecalciferol and calcium supplementation on bone loss after transplantation in renal transplant patients.


METHODS
Fifty-eight renal transplantation patients were included in the study. Fourteen newly transplanted patients (group 1) and 44 renal transplantation patients with a graft age of at least six months (group 2) were involved. All patients received 400 IU/day orally cholecalciferol (vitamin D3) and 600 mg/day orally calcium replacement starting from the second day posttransplantation. All patients baseline serum and urine biochemistry, serum 25-hydroxy vitamin D3 (25 (OH)D3), and bone mineral density (BMD) tests were performed. Also, the same measurements were performed at the 12th month in group 1.


RESULTS
After one year of treatment, BMDs were improved in group 1. Patients in group 1 had a nonsignificant increase of lumbar spine (8.12 +/- 18.64% of baseline BMD) and femoral total (7.10 +/- 13.48% of baseline BMD) BMD at the end of the first year. On the other hand, there was a significant increase in femoral neck (10.06 +/- 15.70% of baseline BMD, p < 0.05) measurements. The baseline results of group 2 were similar to group 1. In group 1, 25 (OH)D3 levels were increased while PTH levels were decreased at the end of the year.


CONCLUSIONS
In renal transplant patients who use low-dose metilprednisolon and new immunosuppressive agents together, low doses of vitamin D3 and calcium replacement for one year provides a reduction in lumbar spine, femoral neck, and femoral total bone loss and prevents bone loss in group 2. In addition, it contributed to the normalization of PTH levels.
Sahin
Garip
G
Department of Nephrology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey. garipsahin@superonline.com
Yasar
Nazife Sule
NS
Sirmagul
Basar
B
Bal
Cengiz
C
Yalcin
Ahmet Ugur
AU
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D015519:Bone Density; D001862:Bone Resorption / Q000209:etiology / Q000517:prevention & control*; D002118:Calcium / Q000627:therapeutic use*; D002762:Cholecalciferol / Q000627:therapeutic use*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D002762:Cholecalciferol; D002118:Calcium