Ibandronate and calcitriol reduces fracture risk, reverses bone loss, and normalizes bone turnover after LTX.
BACKGROUND
Osteoporosis is a common complication in long-term survivors after liver transplantation (LTX). This study investigates the influence of a combination therapy of low dose parenteral ibandronate (IBN) and calcitriol on top of calcium and vitamin D supplementation in such patients.


METHODS
For 3 years, 30 osteoporotic patients after LTX (28±6 months) were treated with quarterly 2 mg IBN intravenously and daily calcitriol (0.25-1.0 μg) on top of 1000 mg calcium and 800 IU vitamin D. Recipients with normal bone density (n=24) were enrolled as controls. Laboratory analysis and dual energy X-ray absorptiometry were performed at baseline and every 12 months. Primary endpoints were changes in bone mineral density and fracture incidence.


RESULTS
IBN patients showed a significant increase of bone mineral density at the femoral neck and the trochanteric region (13% and 15%, respectively, both P=0.001) as compared with baseline whereas the control group revealed a small but significant loss of -5.0% in the trochanteric and -4.9% in the neck region (P<0.05) over the same time period. Fracture incidence was low among IBN patients (7%); however, 23% of the control patients sustained at least one vertebral fracture. The relative fracture risk was 3.21 for IBN patients (95% confidence interval, 0.6-20.9, P=0.03) resulting in an absolute risk reduction for a new vertebral fracture of 14%.


CONCLUSIONS
In LTX recipients with osteoporosis combination therapy with low dose IBN and calcitriol on top of calcium and vitamin D supplementation is an effective treatment option.
Division of Transplantation, Department of Surgery, Medical University Graz, Graz, Austria. doris.wagner@medunigraz.at
Doris
D
Wagner
Karin
K
Amrein
Hans Peter
HP
Dimai
Daniela
D
Kniepeiss
Karl Heinz
KH
Tscheliessnigg
Peter
P
Kornprat
Harald
H
Dobnig
Thomas
T
Pieber
Astrid
A
Fahrleitner-Pammer
D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D016723:Bone Remodeling / Q000187:drug effects*; D002117:Calcitriol / Q000008:administration & dosage*; D004164:Diphosphonates / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D000077557:Ibandronic Acid; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000097:blood; D012306:Risk
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase; D002117:Calcitriol; D000077557:Ibandronic Acid