Related Experiment Videos
Prevention of bone loss after heart transplantation with antiresorptive therapy: a pilot study
E Shane1, M A Rodino, D J McMahon
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. es54@columbia.edu
Insights
Bisphosphonate therapy with calcitriol significantly reduced bone loss and fractures in heart transplant patients. This treatment shows promise for preventing osteoporosis after heart transplantation.
Area of Science:
- Cardiology
- Endocrinology
- Orthopedics
Background:
- Heart transplantation treatments cause significant bone loss and fractures.
- Post-transplant bone loss is linked to decreased vitamin D and increased bone resorption.
- Bisphosphonates, which inhibit bone resorption, were investigated for preventing this bone loss.
Purpose of the Study:
- To evaluate the efficacy of bisphosphonates in preventing bone loss after heart transplantation.
- To compare bone mineral density and fracture rates in patients receiving bisphosphonates versus those who did not.
Main Methods:
- 18 heart transplant patients received pamidronate and etidronate with calcitriol.
- 52 heart transplant patients (historical group) received only calcium and vitamin D.
- Bone mineral density and bone resorption markers were monitored serially.
Main Results:
- Lumbar spine bone loss was negligible in the bisphosphonate group versus 6.8% in the control group.
- Femoral neck bone density decreased by 2.7% in the bisphosphonate group vs. 10.6% in the control group.
- Fracture incidence was significantly lower in the bisphosphonate group (2 patients) compared to the control group (17 patients).
Conclusions:
- Bisphosphonates combined with calcitriol effectively reduce bone loss and fractures post-heart transplantation.
- This therapeutic approach shows potential for managing transplantation-related osteoporosis.
- Further research is warranted to confirm long-term efficacy and safety.
Background:
Heart transplantation, with its attendant glucocorticoid and cyclosporine therapy, has deleterious effects on the skeleton. We have previously reported rapid bone loss and high fracture rates (36% of patients) during the first year after heart transplantation. The bone loss was accompanied by declines in serum 1,25-dihydroxyvitamin D and osteocalcin levels and increased urinary excretion of markers of bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline). We therefore investigated whether bone loss could be prevented by bisphosphonates, agents that inhibit bone resorption.
Methods:
Serial measurements of bone mineral density (BMD) and biochemical indexes of mineral metabolism were compared in 18 group A patients who received a single intravenous infusion of pamidronate (60 mg) within 2 weeks of heart transplantation, followed by 4 cycles of oral etidronate (400 mg daily for 14 days every 3 months) and oral calcitriol 0.25 microg daily, to those of 52 patients who previously underwent transplantation (group B) who did not receive antiresorptive therapy. Both groups received elemental calcium 1000 mg and vitamin D 400 IU daily.
Results:
At 12 months after transplantation, there was virtually no lumbar spine bone loss in group A patients, whereas lumbar spine BMD had declined significantly in group B patients (0.2% +/- 0.9% vs 6.8% +/- 1.0%, respectively; P < .0001). Similarly, femoral neck BMD fell by 10.6% +/- 1.1% in group B patients and by only 2.7% +/- 1.4% in group A patients (P < .0001). Three incident vertebral fractures occurred in two group A patients, whereas 17 group B patients sustained 30 incident vertebral fractures, one hip fracture and three episodes of rib fractures (P < .02; test of proportions). With respect to markers of bone resorption, urinary deoxypyridinoline fell by 51% +/- 9% in group A patients and increased by 65% +/- 22% in group B patients by 3 months after transplantation (P < .0001).
Conclusion:
In summary, heart transplant recipients treated with bisphosphonates and replacement doses of calcitriol sustained less bone loss and fewer fractures than those treated with calcium and vitamin D. We conclude that bisphosphonate therapy, in conjunction with calcitriol, shows promise for prevention of transplantation-related osteoporosis.