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Weekly oral bisphosphonates over 2 years prevent bone loss in cardiac transplant patients

Uwe Lange1,2, Katharina Classen3, Ulf Müller-Ladner1,4

  • 1Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim, Germany.

Clinical Transplantation
|September 24, 2017
PubMed

Insights

Oral bisphosphonates, calcium, and vitamin D effectively preserved bone mass and prevented fractures in heart transplant recipients. Regular monitoring and treatment of bone density are recommended post-transplantation.

Area of Science:

  • Cardiology
  • Endocrinology
  • Orthopedics

Background:

  • Heart transplantation (HTX) is a standard therapy for end-stage heart disease.
  • Osseous complications are a concern following HTX.
  • This study investigated bisphosphonates for preventing bone issues post-HTX.

Purpose of the Study:

  • To evaluate the efficacy of oral bisphosphonates in preventing osseous complications after heart transplantation.
  • To assess the impact of bisphosphonates on bone mineral density and bone metabolism markers.

Main Methods:

  • 33 heart transplant recipients received weekly alendronate or risedronate with calcium and vitamin D.
  • Bone mineral density (BMD) via DXA, bone metabolism markers (osteocalcin, crosslaps), and cytokine levels (OPG, RANKL) were measured.
  • Primary endpoints included changes in BMD, bone markers, OPG, RANKL, and fracture incidence over 2 years.

Main Results:

  • BMD remained stable, with 2 patients improving from osteoporosis to osteopenia; no fractures occurred.
  • Serum osteoprotegerin (OPG) levels increased significantly, while receptor activator of NF-kappa-B ligand (RANKL) and the RANKL/OPG ratio decreased.
  • No significant changes were observed in serum crosslaps; BMD correlated with vitamin D levels in females.

Conclusions:

  • Weekly oral bisphosphonates with calcium and vitamin D supplementation preserve bone mass in heart transplant patients.
  • This regimen prevents the uncoupling of bone resorption/formation and reduces fracture risk.
  • Regular bone density measurement and bisphosphonate treatment are advised for heart transplant recipients.
Abstract

Keywords:
complication: medical/metabolicdiagnostic techniques and imagingdrug interactionmonitoring: physiologic

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