Effect of pamidronate on bone loss after kidney transplantation: a randomized trial

Am J Kidney Dis. 2009 May;53(5):856-65. doi: 10.1053/j.ajkd.2008.11.036.


Background: Kidney transplantation is associated with an increased risk of bone fracture and rapid loss of bone mineral density after kidney transplantation.

Study design: Randomized controlled trial.

Setting & participants: Patients were randomly assigned to treatment (n = 46) or control (no treatment; n = 47) groups. Patients were stratified according to parathyroid hormone level and sex. Those with parathyroid hormone level less than 150 pg/mL were excluded.

Intervention: The treatment and control groups received pamidronate, 1 mg/kg, perioperatively and then at 1, 4, 8, and 12 months or no treatment, respectively. All received calcium (500 mg) and vitamin D (400 units) daily. Immunosuppression was cyclosporine and prednisolone, with no difference in dosing between the 2 groups.

Outcomes & measurements: Bone mineral density was evaluated by means of dual-energy x-ray absorptiometry of the lumbar spine and hip at baseline and 3, 6, 12, and 24 months, with the primary end point at 1 year of percentage of change in bone mineral density from baseline. Clinical fractures were recorded and also evaluated by means of spinal radiographs at baseline and 1 and 2 years.

Results: Pamidronate protected bone mineral density at the lumbar spine; bone mineral density increased by 2.1% in the treatment group and decreased by 5.7% in the control group at 12 months (P = 0.001). Protection was also seen in Ward's area of the hip (P = 0.002) and the total hip (P = 0.004). There was no difference in femoral neck bone mineral density loss between the 2 groups. Fracture rates in the treatment and control groups were 3.3% and 6.4% per annum, respectively.

Limitations: This study was not powered to detect differences in fracture rates.

Conclusion: Pamidronate protects against posttransplantation bone loss at the lumbar spine and Ward's area of the hip.

Trial registration: ClinicalTrials.gov NCT00738257.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adolescent
  • Adult
  • Aged
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Resorption / blood
  • Bone Resorption / drug therapy*
  • Bone Resorption / etiology
  • Diphosphonates / administration & dosage
  • Diphosphonates / therapeutic use*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Follow-Up Studies
  • GTP Phosphohydrolases
  • Humans
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pamidronate
  • Parathyroid Hormone / blood
  • Postoperative Complications
  • Radioimmunoassay
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Bone Density Conservation Agents
  • Diphosphonates
  • Parathyroid Hormone
  • GTP Phosphohydrolases
  • Pamidronate

Associated data

  • ClinicalTrials.gov/NCT00738257