Calcimimetics and bone mineral density in renal transplant patients with persistent secondary hyperparathyroidism

The persistence of secondary hyperparathyroidism plays an important role in posttransplant bone loss. Calcimimetics are efficient to control metabolic alterations associated with this problem, but there are few publications that assess their effects on bone density.

This prospective study assessed the effects of a single daily dose of cinacalcet on calcemia, phosphatemia, parathyroid hormone (PTH), and bone densitometry (femur and spine) values of 27 renal transplant patients with stable kidney function, calcium > 10.5 mg/dL, and PTH > 65 pg/mL.

A preliminary study after 6 months showed decreased calcemia (11.05 +/- 0.5 to 10.18 +/- 0.6 mg/dL; P < .0001), reduced levels of intact PTH (iPTH; 258 +/- 104 to 209.61 +/- 127 pg/mL; P < .05), and increased phosphatemia (2.38 +/- 0.45 to 2.54 +/- 0.3 mg/dL; P < .05). We also observed an increase in femoral neck bone mass with improved T score (-1.36 +/- 1.19 to -1.05 +/- 0.84 g/cm(2); P < .05).

Cinacalcet was effective in the management of posttransplant persistent secondary hyperparathyroidism, resulting in decreased calcemia and iPTH, while also improving femoral neck bone loss. Longer-term studies with control groups are needed to determine the drug's influence on overall bone mineral density.