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Osteoporosis after cardiac transplantation
E Shane1, M C Rivas, S J Silverberg
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
The American Journal of Medicine
|March 1, 1993
Summary
Osteopenia and fractures are common after cardiac transplantation. Elevated osteocalcin suggests a unique osteoporosis cause, differing from typical glucocorticoid effects.
Area of Science:
- Endocrinology
- Nephrology
- Orthopedics
Background:
- Cardiac transplantation requires long-term immunosuppression, often involving glucocorticoids.
- Glucocorticoid therapy is known to increase the risk of bone loss and fractures.
- The specific impact on bone metabolism post-cardiac transplant requires further investigation.
Purpose of the Study:
- To determine the prevalence of osteopenia and fractures in cardiac transplant recipients.
- To describe biochemical indices of mineral metabolism in this patient population.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) for bone densitometry of the lumbar spine and femoral neck.
- Radiographs of the thoracic and lumbar spine to assess for vertebral fractures.
- Analysis of routine and specialized biochemical markers, including intact parathyroid hormone, vitamin D metabolites, and osteocalcin.
Main Results:
- Osteopenia was observed in 28% of patients at the lumbar spine and 20% at the femoral neck.
- Vertebral fractures were present in 35% of the studied cardiac transplant recipients.
- Elevated serum osteocalcin levels, a bone formation marker, were found in 60% of patients.
Conclusions:
- Osteopenia and vertebral fractures are highly prevalent following cardiac transplantation.
- Elevated osteocalcin levels in these patients suggest a distinct pathogenic mechanism for osteoporosis compared to typical glucocorticoid-induced bone disease.