Hip geometry and strength remain stable the first year after kidney transplantation-an ibandronate/placebo post hoc analysis
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Published on: February 27, 2018
Ruth C Strømmen1,2, Kristin Godang3, Markus H Hovd1,4
1Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, N-0424, Oslo, Norway.
Insights
Bone mineral density (BMD) has low sensitivity for fracture risk in kidney transplant recipients (KTR). Hip Structure Analysis (HSA) did not show significant changes in hip geometry or strength with 12-month antiresorptive therapy in KTR.
Area of Science:
- Nephrology and Endocrinology
- Bone Metabolism and Biomechanics
- Transplantation Medicine
Background:
- Bone mineral density (BMD) has limited efficacy in identifying fracture risk among kidney transplant recipients (KTR).
- Alternative methods like Hip Structure Analysis (HSA) are needed to assess bone strength in KTR.
- Antiresorptive therapies are commonly used in KTR, but their impact on hip structural geometry and strength is not well understood.
Purpose of the Study:
- To investigate the effect of 12-month antiresorptive therapy (ibandronate) on hip geometrical and strength parameters using Hip Structure Analysis (HSA).
- To evaluate changes in specific HSA measures including cortical bone thickness, femur neck width, hip axis length, buckling ratio, and strength index in KTR.
Main Methods:
- Post hoc analysis of a 12-month randomized, double-blind, placebo-controlled trial involving 127 de novo KTR.
- Dual X-ray absorptiometry (DXA) scans of the hip were analyzed using HSA to measure geometrical and strength parameters at baseline, 10 weeks, and 1 year post-transplant.
- Measurements included cortical bone thickness (CBT) at the femoral neck, calcar, and shaft, alongside other hip structural parameters and stability indices.
Main Results:
- Hip geometrical and strength parameters, as assessed by HSA, remained stable throughout the first post-transplant year, regardless of ibandronate treatment.
- No statistically significant differences were observed in any HSA measures between the ibandronate and placebo groups.
- Changes in hip geometry and buckling ratio did not correlate with changes in parathyroid hormone levels or BMD.
Conclusions:
- Twelve months of antiresorptive therapy with ibandronate did not significantly alter hip geometry or strength parameters measured by HSA in kidney transplant recipients.
- HSA measures did not demonstrate sensitivity to detect changes induced by antiresorptive therapy in this KTR cohort over one year.
- Further research is warranted to explore other potential markers or longer-term effects on bone health in KTR.
Abstract:
The sensitivity of bone mineral density (BMD) to identify patients with high fracture risk after kidney transplantation is low, therefore alternative tools are needed. Hip Structure Analysis (HSA) provides an estimation of hip structural geometry and strength based on conventional DXA scans for hip analyses. We aimed to investigate the effect of antiresorptive therapy on hip geometrical and strength parameters by HSA. In a post hoc analysis of a 12-month randomized, double-blind, placebo-controlled trial evaluating the effect of ibandronate in addition to active vitamin D and calcium in kidney transplant recipients (KTR), we re-analyzed dual total hip and femoral neck DXA scans to measure cortical bone thickness (CBT) in the femoral neck (CBTNECK), calcar (CBTCALCAR), and shaft (CBTSHAFT), along with femur neck width, hip axis length, and to estimate buckling ratio and strength index. DXA measurements were performed within 5 weeks after transplantation and repeated at 10 weeks and 1-year post-transplant. The study included a total of 127 de novo KTR with estimated glomerular filtration rate >30 mL/min at baseline. The 5 geometrical and the strength and stability hip parameters remained stable over the first post-transplant year irrespective of antiresorptive therapy. We detected no statistically significant between-group differences in any of the HSA measures. Change in geometrical hip parameters and buckling ratio over the study duration was not correlated with change in plasma parathyroid hormone or change in dual total hip BMD. In this study, the so far largest of HSA in KTR, antiresorptive therapy with ibandronate for 12 months did not affect measures of hip geometry or strength. Clinical Trial Registration: www.clinicaltrials.gov as NCT00423384, EudraCT number 2006-003884-30.
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