Osteoporosis and bone morbidity in cardiac transplant recipients

Lee, Albert H.; Mull, Rebekah; Keenan, Gregory F.; Callegari, Peter E.; Dalinka, Murray K.; Eisen, Howard J.; Mancini, Donna; DiSesa, Verdi J.; Attie, Maurice F.

doi:10.1016/0002-9343(94)90113-9

Cited by 178 publications

(92 citation statements)

References 27 publications

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“…Previous studies have demonstrated a 30 to 35% increase of the incidence of lumbar fracture following heart and liver transplantation and an 8 to 17% loss of BMD within 1 yr following kidney transplantation (1)(2)(3)(4)(5). However, little is known about the effect of BMT on the skeletal system.…”

Section: Discussionmentioning

confidence: 99%

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The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

et al. 2002

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INTRODUCTIONWith improved survival following transplantation, increasing importance is now being placed upon the long-term effects of therapy including osteoporosis. Several reviews regarding bone complications in transplanted patients have appeared in the literature (1-5). Most of these works refer to renal, hepatic, and cardiac transplants, whereas references to bone marrow transplantation (BMT) remain scarce, especially about the long-term changes in bone mineral metabolism. Bone diseases following BMT show several differences from those following other organ transplants. BMT recipients are relatively young and the duration of immunosuppressive therapy is usually short. The duration from diagnosis to BMT is relatively short, and thus pre-transplant bone mineral density (BMD) in BMT is higher than those in other solid organ transplantation (6). However, loss of bone mineral density is usually detected following BMT in short-term studies (6-9).We previously reported one-year change of bone mineral metabolism in which early bone loss is significant after BMT (7). However, data on the long-term change of BMD following BMT are rare. We observed the changes of yearly BMD during the post-BMT 3 yr and found a unique pattern in the bone loss and recovery according to the skeletal sites. PATIENTS AND METHODSWe prospectively investigated 11 patients (5 females and 6 males) undergoing allogeneic BMT for hematologic diseases (7 with leukemia, 3 with severe aplastic anemia, and 1 with myelodysplastic syndrome). The mean age of patients was 28.7 ±8.6 yr at the time of BMT (Table 1). Each patient received high dose cyclophosphamide (60 mg/kg/day) for two to four days. Six patients also received total body irradiation (TBI, 10-13.2 Gy) as a conditioning regimen. Intravenous cyclosporin A was administered at a dose of 5 mg/kg/day one day before BMT and at 3 mg/kg/day until the 20th day after BMT to the patients in order to prevent graft-versus-host disease (GVHD). Thereafter, oral cyclosporin A at 6 mg/kg/day was begun and continued for 6 to 12 months. Chronic GVHD developed in 3 patients. Established GVHD was treated with a combination of intravenous methylprednisolone or oral prednisolone and cyclosporin A. Doses were tapered when GVHD was controlled clinically.During the 3-yr study period, pre-BMT and yearly BMD were measured. BMDs of the lumbar spine (lumbar vertebrae L2-L4) and of the total proximal femur were measured by dual-energy radiography absorptiometry (DEXA) using a Lunar Expert (Lunar, Madison, WI, U.S.A. Loss of bone mass is usually detected after bone marrow transplantation (BMT) during the early post-transplant period. However, little is known about the long-term effects of BMT on bone metabolism. We have prospectively investigated 11 patients undergoing BMT. Bone mineral density (BMD) was measured before BMT, and 1, 2, and 3 yr after BMT. Serum markers of bone turnover were serially measured before BMT and 1, 2, 3, 4, and 12 weeks, 6 months, and 1 yr after BMT. The mean change in the lumbar spine (L2-4) BMD,...

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Section: Discussionmentioning

confidence: 99%

“…Several reviews regarding bone complications in transplanted patients have appeared in the literature (1)(2)(3)(4)(5). Most of these works refer to renal, hepatic, and cardiac transplants, whereas references to bone marrow transplantation (BMT) remain scarce, especially about the long-term changes in bone mineral metabolism.…”

Section: Introductionmentioning

confidence: 99%

The Skeletal Site-Differential Changes in Bone Mineral Density Following Bone Marrow Transplantation: 3-Year Prospective Study

et al. 2002

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“…Levels below 50 nmol/l can be associated with low intestinal calcium absorption rates (Barger-Lux et al, 1995) and elevated serum PTH levels (Malabanan et al, 1998), and might thus predispose to an increased risk for a negative calcium balance and bone loss. In line with this suggestion, CHF patients have elevated urinary concentrations of bone resorption markers (Christ et al, 1996;Shane et al, 1997), low blood levels of bone formation markers (Nishio et al, 2003;Schleithoff et al, 2003), low bone mineral densities (Muchmore et al, 1992;Lee et al, 1994;Van Cleemput et al, 1995;Thiebaud et al, 1996;Shane et al, 1997;Rodino and Shane, 1998), and a high osteoporotic fracture risk (Shane et al, 1997). It has recently been suggested that the low femoral bone mineral density in CHF patients is at least in part related to low serum 25(OH)D concentrations (Kenny et al, 2006).…”

Section: Introductionmentioning

confidence: 91%

Combined calcium and vitamin D supplementation is not superior to calcium supplementation alone in improving disturbed bone metabolism in patients with congestive heart failure

et al. 2007

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Objectives: To clarify the potential role of vitamin D supplementation on bone metabolism in congestive heart failure (CHF) patients with low vitamin D status and insufficient dietary calcium intake. Subjects/Methods: One hundred and two ambulatory male CHF patients were recruited, of whom the majority was treated with loop diuretics. Nine patients died during follow-up. Additional 14 participants dropped out prematurely because their health status worsened markedly. Five patients had to be excluded due to lack of compliance. A daily vitamin D3 supplement plus 500 mg calcium (CaD group) or a placebo plus 500 mg calcium (Ca group) was given for 9 months. Biochemical parameters of vitamin D and bone metabolism were analyzed at baseline and after 9 months. Results: Median 25-hydroxyvitamin D concentrations increased from 41.7 to 103.0 nmol/l (Po0.001) in the CaD group and remained constant in the Ca group, while median calcium intake increased above 1200 mg/day in both groups. The percentage of patients with elevated parathyroid hormone levels (460 pg/ml), as well as the serum concentration of undercarboxylated osteocalcin, an indicator of osteoporotic fracture risk and the bone resorption marker C-telopeptide fell significantly in both study groups (Po0.025-0.001). At the end of the study period, biomarkers of bone turnover did not differ between groups. Conclusions: A vitamin D3 supplement of 50 mg/day has no additional beneficial effects on markers of bone metabolism in CHF patients with low initial 25-hydroxyvitamin D concentrations if an adequate daily calcium intake is guaranteed.

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“…70 -72 The risk for fractures is highest in those with osteoporosis, but fractures may develop even in those with normal bone density before transplantation. 71,72 Most bone loss occurs in the first 6 to 12 months after transplantation when steroid doses are highest. 73 Bisphosphonates have been shown to prevent bone loss and fractures in nontransplant patients receiving glucocorticoids.…”

Section: Osteoporosismentioning

confidence: 99%