Alfacalcidol and Calcitriol in the Prevention of Bone Loss after Organ Transplantation

Sambrook, Philip N.

doi:10.1007/s002239900709

Cited by 34 publications

(9 citation statements)

References 19 publications

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“…Administration of vitamin D or its analogues is often recommended to prevent or treat osteoporosis after transplantation [58]. There are several potential mechanisms by which vitamin D and its analogues may influence post-transplantation bone loss.…”

Section: Treatment Of Post-transplant Bone Loss With Vitamin D and Anmentioning

confidence: 99%

Vitamin D in organ transplantation

Stein

Shane

2011

Osteoporos Int

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Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)2D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.

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Section: Treatment Of Post-transplant Bone Loss With Vitamin D and Anmentioning

confidence: 99%

Vitamin D in organ transplantation

Stein

Shane

2011

Osteoporos Int

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“…More promising results have been found in studies using active metabolites of vitamin D, such calcidiol (25‐hydroxyvitamin D), alfacalcidol (1α‐hydroxyvitamin D), or calcitriol (1,25‐dihydroxyvitamin D). Vitamin D metabolites probably reduce post‐transplantation bone loss by reversing glucocorticoid‐induced decreases in intestinal calcium absorption and directly or indirectly suppressing parathyroid hormone (PTH) secretion (29) …”

Section: Prevention Of Bone Loss After Transplantationmentioning

confidence: 99%

Management of Bone Loss After Organ Transplantation

Cohen

Sambrook

Shane

2004

Journal of Bone and Mineral Research

101

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Organ transplant recipients experience rapid bone loss and high fracture rates, particularly during the early post-transplant period. Early rapid bone loss occurs in the setting of uncoupled bone turnover with increased bone resorption and decreased bone formation. Because there are no clinical factors that reliably predict posttransplant bone loss and fractures in the individual patient, all transplant recipients should be considered candidates for early preventive therapy for osteoporosis. Long-term transplant recipients with densitometric osteoporosis and/or fractures should also receive treatment. Although active metabolites of vitamin D and bisphosphonates have both shown efficacy, data from clinical trials suggest that bisphosphonates are the safest and most consistently effective agents for the prevention and treatment of post-transplantation osteoporosis in adults. Kidney transplant recipients represent a special population, and more research is needed to delineate the risks and benefits of treating bone disease in these patients.

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“…Bone loss is also attenuated with subcutaneous or intranasal calcitonin [14,25]. Grotz et al [14] evaluated the efficacy of calcitonin and clodronate in combination with calcium compared to control group with supplemental calcium alone in 46 RTx recipients who had posttransplant osteopenia, with a significant increase in BMD at the lumber spine in the 3 groups compared to the basal values, but with no difference observed between among the 3 groups.…”

Section: Discussionmentioning

confidence: 99%