Effect of pamidronate on bone loss after kidney transplantation: a randomized trial.
BACKGROUND
Kidney transplantation is associated with an increased risk of bone fracture and rapid loss of bone mineral density after kidney transplantation.


METHODS
Randomized controlled trial.


METHODS
Patients were randomly assigned to treatment (n = 46) or control (no treatment; n = 47) groups. Patients were stratified according to parathyroid hormone level and sex. Those with parathyroid hormone level less than 150 pg/mL were excluded.


METHODS
The treatment and control groups received pamidronate, 1 mg/kg, perioperatively and then at 1, 4, 8, and 12 months or no treatment, respectively. All received calcium (500 mg) and vitamin D (400 units) daily. Immunosuppression was cyclosporine and prednisolone, with no difference in dosing between the 2 groups.


METHODS
Bone mineral density was evaluated by means of dual-energy x-ray absorptiometry of the lumbar spine and hip at baseline and 3, 6, 12, and 24 months, with the primary end point at 1 year of percentage of change in bone mineral density from baseline. Clinical fractures were recorded and also evaluated by means of spinal radiographs at baseline and 1 and 2 years.


RESULTS
Pamidronate protected bone mineral density at the lumbar spine; bone mineral density increased by 2.1% in the treatment group and decreased by 5.7% in the control group at 12 months (P = 0.001). Protection was also seen in Ward's area of the hip (P = 0.002) and the total hip (P = 0.004). There was no difference in femoral neck bone mineral density loss between the 2 groups. Fracture rates in the treatment and control groups were 3.3% and 6.4% per annum, respectively.


CONCLUSIONS
This study was not powered to detect differences in fracture rates.


CONCLUSIONS
Pamidronate protects against posttransplantation bone loss at the lumbar spine and Ward's area of the hip.
Walsh
Stephen B
SB
The Centre for Nephrology, Royal Free Hospital, London, UK. stephen.walsh@ucl.ac.uk
Altmann
Paul
P
Pattison
James
J
Wilkie
Martin
M
Yaqoob
Muhammad M
MM
Dudley
Christopher
C
Cockwell
Paul
P
Sweny
Paul
P
Banks
Linda M
LM
Hall-Craggs
Margaret
M
Noonan
Kate
K
Andrews
Christopher
C
Cunningham
John
J
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001862:Bone Resorption / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D020558:GTP Phosphohydrolases; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications; D011863:Radioimmunoassay; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D020558:GTP Phosphohydrolases; D000077268:Pamidronate