Mechanisms of bone loss after cardiac transplantation

Guo, Chun; Johnson, A. G.; Locke, T. J.; Eastell, Richard

doi:10.1016/s8756-3282(97)00269-x

Cited by 64 publications

(27 citation statements)

References 25 publications

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“…Nevertheless, in those series no relationship with creatinine and BMD was shown. PTH levels were inversely correlated with BMD evolution at the femoral neck, suggesting that secondary hyperparathyroidism contributes to cortical bone loss [27].…”

Section: Discussionmentioning

confidence: 99%

Bone Disease After Liver Transplantation: A Long-Term Prospective Study of Bone Mass Changes, Hormonal Status and Histomorphometric Characteristics

Monegal¹,

Navasa²,

Guañabens³

et al. 2001

Osteoporosis International

164

119

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After liver transplantation there is a high incidence of fractures, with important rates of bone loss during the first months. However, the long-term evolution of bone mass and metabolism parameters have been scarcely studied. In order to determine the incidence and risk factors involved in the development of skeletal fractures and to analyze the long-term evolution of bone mass, bone turnover and hormonal status after liver transplantation, a 3-year prospective study was performed in 45 patients following liver transplantation. Serum osteocalcin, parathyroid hormone (PTH), 25-hydroxyvitamin D (25-OH D) and testosterone levels (men), and bone mass at the lumbar spine and femur were measured before and sequentially at different time points during 3 years. Spinal X-rays were obtained during the first year. Histomorphometric analysis of bone biopsies obtained in 24 patients within the first 12 hours after surgery and 6 months after transplantation was performed. Fifteen patients (33%) developed fractures after liver transplantation, and pre-transplant risk factors for fractures were age and low bone mass (odd's ratio for osteoporosis, 95% confidence interval: 5.69, 1.32-24.53). Serum PTH, osteocalcin, 25-OH D, testosterone and creatinine levels increased after transplantation. Moreover, PTH correlated with creatinine and osteocalcin values. Bone mass decreased during the first 6 months and reached baseline values at the lumbar spine the second year, with posterior significant recovery at the femoral neck. Long term evolution of femoral neck BMD correlated with PTH levels. Six months after transplantation bone histomorphometric data showed an increase in bone formation parameters. After liver transplantation there is a high incidence of fractures, specially in elderly patients and those with osteoporosis. Bone mass decreased in the short-term period and improved, initially at the lumbar spine and later at the femur, according to histomorphometric evidences of an increase in bone formation. The increase in creatinine values induces a secondary hyperparathyroidism that influences the changes in femoral bone mass. Treatment of osteoporosis shortly after liver transplantation may be important in the prevention of bone fractures, particularly in patients with low bone mass.

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Section: Discussionmentioning

confidence: 99%

Bone Disease After Liver Transplantation: A Long-Term Prospective Study of Bone Mass Changes, Hormonal Status and Histomorphometric Characteristics

Monegal¹,

Navasa²,

Guañabens³

et al. 2001

Osteoporosis International

164

119

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“…Patients with cardiac disease frequently receive loop diuretics which increase urinary calcium loss and may lead to secondary hyperparathyroidism. Elevated parathyroid hormone (PTH) levels have been reported in some [2,11,17] but not all studies of cardiac transplant bone loss [5]. Guo et al [17] found elevated serum osteocalcin, serum bone-specific alkaline phosphatase, and urinary NTX (N telopeptide of type I collagen) levels in a cross-sectional study of 50 men after cardiac transplantation, consistent with increased turnover.…”

Section: Rationale For Use Of D-hormones In Transplant Osteoporosismentioning

confidence: 99%

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

Sambrook

1999

Calcif Tissue Int

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There is increasing evidence that D-hormones (active vitamin D metabolites) are effective agents in preventing posttransplantation bone loss of various organs. This effect may relate to several mechanisms including reversal of secondary hyperparathyroidism from cyclosporine, reversal of corticosteroid effects on bone, or immunomodulatory effects with corticosteroid sparing. Further clinical trials are necessary to establish their comparative efficacy to other agents, but D-hormones should be considered as prophylactic therapy in patients undergoing organ transplantation.

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“…In addition, bone mass decreases dramatically after the transplant, at trabecular sites as well as cortical sites [4][5][6][7][8][9][10]. This bone loss is explained by the relatively high doses of glucocorticoids given during the months following the graft, and by the negative effect of cyclosporin A, which probably increases bone turnover [10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Pamidronate as Treatment for Osteoporosis after Heart Transplantation: A Prospective Study

Seydoux²,

Sandini

et al. 2001

Osteoporosis International

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Fractures due to osteoporosis are one of the major complications after heart transplantation, occurring mostly during the first 6 months after the graft, with an incidence ranging from 18% to 50% for vertebral fractures. Bone mineral density (BMD) decreases dramatically following the graft, at trabecular sites as well as cortical sites. This is explained by the relatively high doses of glucocorticoids used during the months following the graft, and by a long-term increase of bone turnover which is probably due to cyclosporine. There is some evidence for a beneficial effect on BMD of antiresorptive treatments after heart transplantation. The aim of this study was to assess prospectively the effect on BMD of a 3-year treatment of quarterly infusions of 60 mg of pamidronate, combined with 1 g calcium and 1000 U vitamin D per day, in osteoporotic heart transplant recipients, and that of a treatment with calcium and vitamin D in heart transplant recipients with no osteoporosis. BMD of the lumbar spine and the femoral neck was measured by dual-energy X-ray absorptiometry in all patients every 6 months for 2 years and after 3 years. Seventeen patients, (1 woman, 16 men) aged 46+/-4 years (mean +/- SEM) received only calcium and vitamin D. A significant decrease in BMD was observed after 6 months following the graft, at the lumbar spine (- 6.6%) as well as at the femoral neck (-7.8%). After 2 years, BMD tended to recover at the lumbar spine, whereas the loss persisted after 3 years at the femoral neck. Eleven patients (1 woman and 10 men) aged 46+/-4 years (mean +/- SEM) started treatment with pamidronate on average 6 months after the graft, because they had osteoporosis of the lumbar spine and/or femoral neck (BMD T-score below -2.5 SD). Over the whole treatment period, a continuous increase in BMD at the lumbar spine was noticed, reaching 18.3% after 3 years (14.3% compared with the BMD at the time of the graft). BMD at the femoral neck was lowered in the first year by -3.4%, but recovered totally after 3 years of treatment. In conclusion, a 3-year study of treatment with pamidronate given every 3 months to patients with existing osteoporosis led to a significant increase in lumbar spine BMD and prevented loss at the femoral neck. However, since some of these patients were treated up to 14 months after the transplant, they may already have passed through the phase of most rapid bone loss. In patients who were not osteoporotic at baseline, treatment with calcium and vitamin D alone was not able to prevent the rapid bone loss that occurs immediately after transplantation.

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Mechanisms of bone loss after cardiac transplantation

Cited by 64 publications

References 25 publications

Bone Disease After Liver Transplantation: A Long-Term Prospective Study of Bone Mass Changes, Hormonal Status and Histomorphometric Characteristics

Bone Disease After Liver Transplantation: A Long-Term Prospective Study of Bone Mass Changes, Hormonal Status and Histomorphometric Characteristics

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

Intravenous Pamidronate as Treatment for Osteoporosis after Heart Transplantation: A Prospective Study

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