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Published on: June 26, 2020
Bone mineral density in long-term Chinese heart transplant recipients: a cross-sectional study
1Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan.
Insights
Bone loss is a significant long-term issue after heart transplantation, affecting 66% of patients at the femoral neck. Higher cyclosporine doses were linked to better bone density, despite normal bone markers.
Area of Science:
- Nephrology
- Orthopedics
- Immunology
Background:
- Osteoporosis is a common complication following heart transplantation, often exacerbated by immunosuppressive medications.
- The specific role of cyclosporine (CsA) in long-term bone loss, particularly at lower doses, requires further investigation.
Purpose of the Study:
- To assess bone mineral density (BMD) in long-term Chinese heart transplant recipients.
- To investigate the relationship between cyclosporine dosage, bone metabolism markers, and bone loss.
Main Methods:
- Cross-sectional study of 41 heart transplant recipients (mean age 50.15 years, mean follow-up 57.02 months).
- Dual-energy x-ray absorptiometry (DXA) for lumbar spine and femoral neck BMD.
- Immunoassays for trough CsA levels and bone metabolism markers (bone-specific alkaline phosphatase, urinary N-telopeptide).
Main Results:
- 66% of patients exhibited bone loss at the femoral neck, more prevalent than at the lumbar spine.
- Higher CsA dosage (<2.5 mg/kg/d) correlated with greater femoral neck BMD and lower serum creatinine.
- Bone loss persisted despite generally normal bone metabolism markers.
Conclusions:
- Bone loss is a persistent issue long after heart transplantation.
- Cyclosporine dosage may influence bone mineral density at the femoral neck in these patients.
- Further research is needed to elucidate the mechanisms of bone loss and optimize management strategies.
Abstract:
Osteoporosis, which usually peaks during 6 to 12 months after transplantation, remains an important concern after heart transplantation. Immunosuppressants contribute to this phenomenon. Glucocorticoids are well documented to cause bone loss, but the role of cyclosporine (CsA) remains controversial, especially among long-term recipients on low doses of steroid. We herein report a cross-sectional study of bone mineral density (BMD) among long-term Chinese heart transplant recipients. We enrolled 41 patients of mean age 50.15 +/- 13.58 years with a mean follow-up of 57.02 months. Lumbar spine and femoral neck BMD were measured by dual energy x-ray absorptiometry. Trough CsA levels (C(0)) and markers of mineral metabolism, including bone-specific alkaline phosphatase and urinary N-telopeptide, were determined by immunoassay. Sixty six percent of subjects showed bone loss at the femoral neck, significantly more than those in the lumbar spine. Those receiving a higher CsA dosage (<2.5 mg/kg/d) showed greater femoral neck BMD, but lower serum creatinine values. Our results demonstrated that bone loss remains long after transplantation, though bone markers are within normal limits.