Bone mineral density and osteoporosis in heart transplanted patients: A single‐center retrospective study at Skåne University Hospital in Lund 1988‐2016

Löfdahl, Eveline; Söderlund, Carl; Rådegran, Göran

doi:10.1111/ctr.13477

Cited by 15 publications

(11 citation statements)

References 27 publications

(37 reference statements)

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“…Most of our patients were treated with calcium substitution and vitamin D supplementation before or immediately after HT; 65% of patients received BP within 1st year, 54% of patients were treated with ZA, and 2 patients received teriparatide. Compared to a study published by Löfdahl, where 35, 38 and 16% received calcium supplements, vitamin D supplements and BP in the first postoperative year respectively [44], the number of treated patients in our cohort was significantly higher. ZA was recognized as the most effective antiresorptive drug for prevention of transplantation bone loss in this population [45].…”

Section: Discussioncontrasting

confidence: 79%

Endocrine disorders after heart transplantation: national cohort study

et al. 2020

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Background: Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post-transplant period. Methods: We conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine followup within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2-4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function. Results: We enrolled 22 women and 101 men of median age 57 years (IQR 50-63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide. Conclusions: The prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.

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Section: Discussioncontrasting

confidence: 79%

Endocrine disorders after heart transplantation: national cohort study

et al. 2020

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“…Osteopenia or osteoporosis may develop in HT patients especially in the first year and with improper preventive management [11]. Glucocorticoids bind osteoprotegerin (OPG); this molecule is necessary for limiting bone resorption.…”

Section: Introductionmentioning

confidence: 99%

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

et al. 2021

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Vitamin D (VD) deficiency is frequently reported in heart transplant (HT) recipients and routinely supplemented. However, the efficacy of VD supplementation on bone mineral density (BMD) and its association with all-cause mortality is underinvestigated. The VD levels and BMD were studied for two years, and the association of VD and BMD with all-cause mortality risk was investigated. Ninety-six HT patients (38.18 ± 12.10 years old; 74% men) were followed up during VD, Ca, and Mg supplementation. Anthropometric measurements, BMD by Dual-energy X-ray absorptiometry (DEXA) scan, VD concentrations, and related biochemical parameters were analyzed before, 1 year, and 2 years after HT. Despite significant improvement of VD3 and 25-hydroxy VD (25OHVD) levels especially in the men, BMD parameters were insignificantly changed. After 2 years, the all-cause mortality rate was 15.6%. High pretransplant levels of 25OHVD failed to improve the survival probability. Cox’s regression showed a 32.7% increased hazard ratio for each unit increase in body mass index (95% CI: 1.015–1.733, p = 0.038), in the VD-deficient group rather than in the VD-sufficient one. In conclusion, VD supplementation improves the biochemical status, especially in VD-deficient HT. However, its impact on the BMD and mortality was not as usually expected. Further investigation of the disturbed VD metabolism in HT is warranted.

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“…Patients who undergo heart transplantation (HT) have increased risk for impaired bone mineral density (BMD) and osteoporosis. 1 The pathophysiology behind impaired BMD in HT patients is multifactorial and includes side effects of the immunosuppressive regimen, given to prevent allograft rejection. 2 Out of the immunosuppressive agents, corticosteroids (CS) have the greatest negative impact on BMD, but calcineurin inhibitors, such as tacrolimus, also impair BMD.…”

Section: Introductionmentioning

confidence: 99%

“…Patients who undergo heart transplantation (HT) have increased risk for impaired bone mineral density (BMD) and osteoporosis 1 . The pathophysiology behind impaired BMD in HT patients is multifactorial and includes side effects of the immunosuppressive regimen, given to prevent allograft rejection 2 .…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density in pediatric heart transplanted patients: A retrospective single‐center study at Skåne University Hospital in Lund 1988–2016

Löfdahl

Lundmark

Haggård

et al. 2021

Pediatric Transplantation

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Bone mineral density and osteoporosis in heart transplanted patients: A single‐center retrospective study at Skåne University Hospital in Lund 1988‐2016

Abstract: Bone mineral density (BMD) in the lumbar spine and femoral neck, the incidence of osteoporosis, and survival up to 10 years after heart transplantation (HT) were inves-

Cited by 15 publications

References 27 publications

Endocrine disorders after heart transplantation: national cohort study

Endocrine disorders after heart transplantation: national cohort study

Impact of Vitamin D Supplementation on Bone Mineral Density and All-Cause Mortality in Heart Transplant Patients

Bone mineral density in pediatric heart transplanted patients: A retrospective single‐center study at Skåne University Hospital in Lund 1988–2016

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