Timing and quantification of bone loss in cardiac transplant recipients

Cleemput, Johan Van; Daenen, Wim; Nijs, J; Geusens, Piet; Dequeker, Jan; Vanhaecke, Johan

doi:10.1111/j.1432-2277.1995.tb01503.x

Cited by 53 publications

(18 citation statements)

References 18 publications

(12 reference statements)

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“…The nonsignificant change in BMD after transplantation is in contrast to previous studies. In most studies, BMD decreased significantly during the first year after transplantation [2,5,6,18,19]. Vertebral fractures are reported to occur at a rate of 21-36% within the first year post-transplant [6,18,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Unexpected low incidence of vertebral fractures in heart transplant recipients: analysis of bone turnover

Kerschan‐Schindl¹,

Ruzicka²,

Mahr³

et al. 2008

Transplant Int

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Summary Heart transplantation (HTX) is associated with a reduction in bone mineral density (BMD). Different markers of bone metabolism have been used, and the applied immunosuppressive regimens have also changed over time. This study was performed to re‐investigate bone metabolism in HTX recipients. Twenty‐five HTX recipients were compared with 25 HTX candidates in respect of biochemical parameters of bone metabolism, BMD, and the frequency of fractures for 1 year. Osteopenia or osteoporosis was observed in approximately two‐thirds of the HTX recipients. Nevertheless, only three (12%) HTX recipients developed a vertebral fracture within 1 year after transplantation; no peripheral fractures occurred. Compared with HTX candidates, HTX recipients had lower serum levels of osteocalcin, and higher serum levels of cross‐linked‐N‐telopeptide of type I collagen (NTX). In HTX recipients, osteocalcin initially reached a nadir, increased during the first 3 months, and decreased thereafter. Bone‐specific alkaline phosphatase initially increased and then decreased. Serum levels of NTX and parathyroid hormone remained high throughout the year. Despite a high bone turnover, an unexpectedly low rate of vertebral fractures was registered. Nevertheless, each fragility fracture is a serious complication and we need to take steps to prevent this complication.

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Section: Discussionmentioning

confidence: 99%

Unexpected low incidence of vertebral fractures in heart transplant recipients: analysis of bone turnover

Kerschan‐Schindl¹,

Ruzicka²,

Mahr³

et al. 2008

Transplant Int

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“…1). (1,6,7,9,11,12,14,15) A high incidence of fractures, between 20% and 40% in most studies, has also been documented. Fractures commonly affect the spine, ribs, and long bones and may occur very early after transplantation, sometimes within the first month.…”

Section: Clinical Features Of Transplantation Osteoporosismentioning

confidence: 99%

Management of Bone Loss After Organ Transplantation

Cohen

Sambrook

Shane

2004

Journal of Bone and Mineral Research

100

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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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“…(1,2) The critical time for the occurrence of vertebral fractures, however, is the early post-transplantation period, (3)(4)(5) when patients receive high doses of immunosuppressive drugs. (3,4,(6)(7)(8)(9) Prospective studies after CTP reported incidence rates of vertebral fractures between 15% and 36%. (5,8,10,11) In view of this high fracture rate, an effective preventive strategy is warranted.…”

Section: Introductionmentioning

confidence: 99%

Ibandronate Prevents Bone Loss and Reduces Vertebral Fracture Risk in Male Cardiac Transplant Patients: A Randomized Double-Blind, Placebo-Controlled Trial

Fahrleitner‐Pammer

Piswanger-Soelkner

Pieber

et al. 2009

Journal of Bone and Mineral Research

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Bone loss and fractures are common complications after cardiac transplantation (CTP). The aim of this study was to investigate whether intravenous ibandronate is an effective preventive option. Thirtyfive male cardiac transplant recipients received either ibandronate (IBN) 2 mg intravenously every 3 mo or matching placebo (CTR) in addition to 500 mg calcium carbonate and 400 IE vitamin D 3 . Sera were collected at CTP and every 3 mo thereafter. At baseline and 6 and 12 mo, standardized spinal X-rays and BMD measurements were taken. Bone biopsies were taken at CTP and after 6 mo from six patients. In the IBN group, 13% of the patients sustained a new morphometric vertebral fracture compared with 53% in the CTR group (absolute risk reduction [ARR], 40%; relative risk reduction [RRR], 75%; p = 0.04). BMD remained unchanged with IBN treatment but in the CTR group decreased at the lumbar spine by 25% and at the femoral neck by 23% (both p < 0.0001) over the 1-yr period. Serum bone resorption markers carboxyterminal telopeptide region of type I collagen (sCTX) and TRACP 5b were significantly increased in the CTR group and decreased in the IBN group at all time points compared with baseline. In contrast, both osteocalcin and bone-specific alkaline phosphatase levels showed, after a similar decrease over the first 3 mo in both groups, a marked rise in the CTR subjects and steadily declining levels in the IBN patients throughout the remainder of the study period. Three paired biopsies were available from each group. Despite the small sample size, a difference in the relative change of eroded surface (68% in the CTR versus 223% in the IBN group, p < 0.05) could be shown. Intravenous IBN reduced fractures, preserved bone mass, and prevented uncoupling of bone formation and resorption after CTP. The favorable effects on bone turnover were also supported by histomorphometric findings.

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Timing and quantification of bone loss in cardiac transplant recipients

Cited by 53 publications

References 18 publications

Unexpected low incidence of vertebral fractures in heart transplant recipients: analysis of bone turnover

Unexpected low incidence of vertebral fractures in heart transplant recipients: analysis of bone turnover

Management of Bone Loss After Organ Transplantation

Ibandronate Prevents Bone Loss and Reduces Vertebral Fracture Risk in Male Cardiac Transplant Patients: A Randomized Double-Blind, Placebo-Controlled Trial

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