Bone loss and turnover after cardiac transplantation

Elizabeth Shane, Maria Rivas, Donald J. McMahon, Ronald B. Staron, Shonni J. Silverberg, Markus J. Seibel, Donna Mancini, Robert E. Michler, Keith Aaronson, Vicki Addesso, Sha Hwa Lo

Research output: Contribution to journalArticle

185 Citations (Scopus)

Abstract

Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first rat posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 ± 0.9% (±SEM) at the lumbar spine and 10.5 ± 1.1% at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 ± 0.9% and 0.1 ± 1.0%, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 ± 0.8%/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 ± 0.5%), but was significant during the second (2.1 ± 0.6%; P < 0.01) and third (2.9 ± 0.8%; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 ± 1.3% during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.

Original languageEnglish (US)
Pages (from-to)1497-1506
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume82
Issue number5
StatePublished - 1997
Externally publishedYes

Fingerprint

Bone Remodeling
Heart Transplantation
Bone
Bone and Bones
Femur Neck
Bone Resorption
Vitamin D
Testosterone
Spine
Transplantation
Osteocalcin
Serum
Metabolites
Densitometry
Bone Fractures
Prednisone
Osteogenesis
Biochemistry
Glucocorticoids
Minerals

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Shane, E., Rivas, M., McMahon, D. J., Staron, R. B., Silverberg, S. J., Seibel, M. J., ... Lo, S. H. (1997). Bone loss and turnover after cardiac transplantation. Journal of Clinical Endocrinology and Metabolism, 82(5), 1497-1506.

Bone loss and turnover after cardiac transplantation. / Shane, Elizabeth; Rivas, Maria; McMahon, Donald J.; Staron, Ronald B.; Silverberg, Shonni J.; Seibel, Markus J.; Mancini, Donna; Michler, Robert E.; Aaronson, Keith; Addesso, Vicki; Lo, Sha Hwa.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 82, No. 5, 1997, p. 1497-1506.

Research output: Contribution to journalArticle

Shane, E, Rivas, M, McMahon, DJ, Staron, RB, Silverberg, SJ, Seibel, MJ, Mancini, D, Michler, RE, Aaronson, K, Addesso, V & Lo, SH 1997, 'Bone loss and turnover after cardiac transplantation', Journal of Clinical Endocrinology and Metabolism, vol. 82, no. 5, pp. 1497-1506.
Shane E, Rivas M, McMahon DJ, Staron RB, Silverberg SJ, Seibel MJ et al. Bone loss and turnover after cardiac transplantation. Journal of Clinical Endocrinology and Metabolism. 1997;82(5):1497-1506.
Shane, Elizabeth ; Rivas, Maria ; McMahon, Donald J. ; Staron, Ronald B. ; Silverberg, Shonni J. ; Seibel, Markus J. ; Mancini, Donna ; Michler, Robert E. ; Aaronson, Keith ; Addesso, Vicki ; Lo, Sha Hwa. / Bone loss and turnover after cardiac transplantation. In: Journal of Clinical Endocrinology and Metabolism. 1997 ; Vol. 82, No. 5. pp. 1497-1506.
@article{26e82f4979664bcd8f3d7808df4bb43e,
title = "Bone loss and turnover after cardiac transplantation",
abstract = "Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first rat posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 ± 0.9{\%} (±SEM) at the lumbar spine and 10.5 ± 1.1{\%} at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 ± 0.9{\%} and 0.1 ± 1.0{\%}, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 ± 0.8{\%}/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 ± 0.5{\%}), but was significant during the second (2.1 ± 0.6{\%}; P < 0.01) and third (2.9 ± 0.8{\%}; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 ± 1.3{\%} during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.",
author = "Elizabeth Shane and Maria Rivas and McMahon, {Donald J.} and Staron, {Ronald B.} and Silverberg, {Shonni J.} and Seibel, {Markus J.} and Donna Mancini and Michler, {Robert E.} and Keith Aaronson and Vicki Addesso and Lo, {Sha Hwa}",
year = "1997",
language = "English (US)",
volume = "82",
pages = "1497--1506",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "5",

}

TY - JOUR

T1 - Bone loss and turnover after cardiac transplantation

AU - Shane, Elizabeth

AU - Rivas, Maria

AU - McMahon, Donald J.

AU - Staron, Ronald B.

AU - Silverberg, Shonni J.

AU - Seibel, Markus J.

AU - Mancini, Donna

AU - Michler, Robert E.

AU - Aaronson, Keith

AU - Addesso, Vicki

AU - Lo, Sha Hwa

PY - 1997

Y1 - 1997

N2 - Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first rat posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 ± 0.9% (±SEM) at the lumbar spine and 10.5 ± 1.1% at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 ± 0.9% and 0.1 ± 1.0%, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 ± 0.8%/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 ± 0.5%), but was significant during the second (2.1 ± 0.6%; P < 0.01) and third (2.9 ± 0.8%; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 ± 1.3% during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.

AB - Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first rat posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 ± 0.9% (±SEM) at the lumbar spine and 10.5 ± 1.1% at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 ± 0.9% and 0.1 ± 1.0%, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 ± 0.8%/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 ± 0.5%), but was significant during the second (2.1 ± 0.6%; P < 0.01) and third (2.9 ± 0.8%; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 ± 1.3% during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.

UR - http://www.scopus.com/inward/record.url?scp=8244247771&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=8244247771&partnerID=8YFLogxK

M3 - Article

C2 - 9141540

AN - SCOPUS:8244247771

VL - 82

SP - 1497

EP - 1506

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 5

ER -