Prevalence and treatment of decreased bone density in renal transplant recipients: a randomized prospective trial of calcitriol versus alendronate

Transplantation. 2003 Nov 27;76(10):1498-502. doi: 10.1097/01.TP.0000092523.30277.13.

Abstract

Background: Reduced bone mineral density (BMD) is common in long-term renal transplant recipients and results in a high incidence of fractures. The optimal therapy for these patients is not known.

Methods: Baseline BMD determinations were obtained in 211 long-term adult renal transplant recipients. One hundred and seventeen patients with a reduced BMD (T score < or = -1) were randomly assigned to treatment with alendronate and calcium (n=60) versus calcitriol and calcium (n=57). Of these, 46 and 51 patients, respectively, completed 1 year of treatment. Forty-nine patients who were not eligible or did not consent to the trial were followed prospectively.

Results: Reduced baseline BMD (T score < or = -1) was present in 159 (78.7%) of patients at the lumbar spine or femur. There was no significant loss of BMD in the prospectively followed patients during 2.7 years. The average lumbar BMD increased from 0.984+/-0.149 to 1.025+/-0.143 g/cm2 (P<0.001) with alendronate and from 1.014+/-0.15 to 1.034+/-0.146 g/cm2 (P=0.002) with calcitriol. BMD at the femur increased from 0.809+/-0.092 to 0.836+/-0.107 g/cm2 (P<0.001) with alendronate and from 0.830+/-0.144 to 0.857+/-0.125 g/cm2 (P=0.023) with calcitriol.

Conclusions: One year of treatment with alendronate or calcitriol, both with calcium supplementation, resulted in significant increases in BMD at the lumbar spine and femur, with a trend toward alendronate being more effective at the spine (P=0.082). Further studies are needed to determine whether BMDs continue to increase after 1 year and whether there is any additional benefit to combining vitamin D and alendronate. Larger studies are needed to determine whether treatment decreases fracture rates.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Alendronate / therapeutic use*
  • Azathioprine / therapeutic use
  • Bone Density / drug effects*
  • Bone Resorption / drug therapy*
  • Bone Resorption / etiology
  • Bone Resorption / prevention & control
  • Calcitriol / therapeutic use*
  • Calcium Channel Agonists / therapeutic use
  • Cross-Sectional Studies
  • Cyclosporine / therapeutic use
  • Female
  • Humans
  • Immunosuppression / methods
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Postoperative Complications / drug therapy
  • Postoperative Complications / prevention & control
  • Prednisone / therapeutic use

Substances

  • Calcium Channel Agonists
  • Cyclosporine
  • Calcitriol
  • Mycophenolic Acid
  • Azathioprine
  • Prednisone
  • Alendronate