Cinacalcet decreases bone formation rate in hypercalcemic hyperparathyroidism after kidney transplantation.
OBJECTIVE
Cinacalcet reduces serum calcium in kidney transplant recipients with hypercalcemic hyperparathyroidism. Its effect on bone, however, has not been investigated in this population.


METHODS
We prospectively examined bone turnover, histomorphometry and density as well as serum bone biomarkers in 10 transplant recipients before and after treatment with cinacalcet.


RESULTS
After 18-24 months of treatment with cinacalcet, bone formation decreased in 7, increased in 2, and remained zero in 1 patient (p = 0.11). Trabecular bone volume was maintained. Trabecular number decreased (p = 0.03), but trabecular thickness was unchanged (p = 0.17). Osteoid decreased (p = 0.02) and osteoblast surface increased (p = 0.02). Bone mineral density of the femur remained stable in 1 patient, decreased in 2 patients, but increased in 7 patients (p = 0.153). Serum calcium concentration (p = 0.005), iPTH (p = 0.01) and calcitonin concentration decreased (p = 0.03), while 25(OH) vitamin D(3) increased (p = 0.02). No fractures were reported. Graft function remained stable.


CONCLUSIONS
While cinacalcet might decrease bone formation rate, it did not change bone volume, and bone mineral density of the femur increased. Therefore, the use of cinacalcet in hypercalcemic hyperparathyroidism might be safe with regard to the bone disease present after kidney transplantation.
Borchhardt
Kyra A
KA
Department of Medicine III, Medical University Vienna, Austria. kyra.borchhardt@meduniwien.ac.at
Diarra
Danielle
D
Sulzbacher
Irene
I
Benesch
Thomas
T
Haas
Martin
M
Sunder-Plassmann
Gere
G
D000368:Aged; D015519:Bone Density; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy* / Q000209:etiology; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000494:pharmacology*; D010012:Osteogenesis / Q000187:drug effects*; D016896:Treatment Outcome
D009281:Naphthalenes; D000069449:Cinacalcet