title: Zoledronic acid versus alendronate for the prevention of bone loss after heart or liver transplantation.
abstract: BACKGROUND
  The first year after transplantation is characterized by rapid bone loss.
  
  
  OBJECTIVE
  The aim of this study was to compare zoledronic acid (zoledronate) and alendronate for prevention of transplantation bone loss.
  
  
  METHODS
  A randomized clinical trial was conducted at a transplantation center.
  
  
  METHODS
  The study included 84 adults undergoing heart or liver transplantation and a concurrently transplanted, nonrandomized reference group of 27 adults with T scores greater than -1.5.
  
  
  METHODS
  Alendronate (70 mg weekly for 12 months) or one 5-mg infusion of zoledronate were both initiated 26 ± 8 d after transplantation.
  
  
  METHODS
  The primary outcome was total hip bone mineral density (BMD) 1 yr after transplantation. Secondary outcomes included femoral neck and lumbar spine BMD and serum C-telopeptide, a bone resorption marker.
  
  
  RESULTS
  In the reference group, BMD declined at the spine and hip (P < 0.001). In the randomized groups, hip BMD remained stable. Spine BMD increased in the zoledronate group and did not change in the alendronate group; at 12 months, the 2.2% difference between groups (95% confidence interval, 0.6 to 3.9%; P = 0.009) favored zoledronate. In heart transplant patients, spine BMD declined in the alendronate and increased in the zoledronate group (-3.0 vs. +1.6%, respectively; between-group difference, 4.2%; 95% confidence interval, 2.1 to 6.3%; P < 0.001). In liver transplant patients, spine BMD increased comparably in both groups. Twelve-month C-telopeptide was lower in the zoledronate group than in the alendronate group (79 vs. 49%; P = 0.04).
  
  
  CONCLUSIONS
  One 5-mg infusion of zoledronate and weekly alendronate prevent bone loss at the hip and, in liver transplant patients, increase spine BMD. In heart transplant patients, spine bone BMD remained stable with zoledronate but decreased with alendronate.
authors.affiliation: Department of Medicine, Columbia University Medical Center, Columbia University, New York, New York 10032, USA. es54@columbia.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stein
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Chiyuan
authors.initials: C
authors.lastname: Zhang
authors.forename: Polly
authors.initials: P
authors.lastname: Young
authors.forename: Kavita
authors.initials: K
authors.lastname: Pandit
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Staron
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Susan
authors.initials: S
authors.lastname: Restaino
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
mesh_terms: D000328:Adult; D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use*; D000465:Algorithms; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001862:Bone Resorption / Q000209:etiology / Q000517:prevention & control*; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000534:rehabilitation; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D010919:Placebos; D000077211:Zoledronic Acid; D019386:Alendronate