Prevention of bone loss after heart transplantation with antiresorptive therapy

A pilot study

E. Shane, M. A. Rodino, D. J. McMahon, V. Addesso, R. B. Staron, M. J. Seibel, D. Mancini, Robert E. Michler, Hwa Lo Sha Hwa Lo

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: Heart transplantation, with its attendant glucocorticoid and cyclosporine therapy, has deleterious effects on the skeleton. We have previously reported rapid bone loss and high fracture rates (36% of patients) during the first year after heart transplantation. The bone loss was accompanied by declines in serum 1,25-dihydroxyvitamin D and osteocalcin levels and increased urinary excretion of markers of bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline). We therefore investigated whether bone loss could be prevented by bisphosphonates, agents that inhibit bone resorption. Methods: Serial measurements of bone mineral density (BMI) and biochemical indexes of mineral metabolism were compared in 18 group A patients who received a single intravenous infusion of pamidronate (60 mg) within 2 weeks of heart transplantation, followed by 4 cycles of oral etidronate (400 mg daily for 14 days every 3 months) and oral calcitriol 0.25 μg daily, to those of 52 patients who previously underwent transplantation (group B) who did not receive antiresorptive therapy. Both groups received elemental calcium 1000 mg and vitamin D 400 IU daily. Results: At 12 months after transplantation, there was virtually no lumbar spine bone loss in group A patients, whereas lumbar spine BMD had declined significantly in group B patients (0.2% ± 0.9% vs 6.8% ± 1.0%, respectively; P < .0001). Similarly, femoral neck BMD fell by 10.6% ± 1.1% in group B patients and by only 2.7% ± 1.4% in group A patients (P < .0001). Three incident vertebral fractures occurred in two group A patients, whereas 17 group B patients sustained 30 incident vertebral fractures, one hip fracture and three episodes of rib fractures (P < .02; test of proportions). With respect to markers of bone resorption, urinary deoxypyridinoline fell by 51% ± 9% in group A patients and increased by 65% ± 22% in group B patients by 3 months after transplantation (P < .0001). Conclusions: In summary, heart transplant recipients treated with bisphosphonates and replacement doses of calcitriol sustained less bone loss and fewer fractures than those treated with calcium and vitamin D. Wee conclude that bisphosphonate therapy, in conjunction with calcitriol, shows promise for prevention of transplantation-related osteoporosis.

Original languageEnglish (US)
Pages (from-to)1089-1096
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume17
Issue number11
StatePublished - 1998
Externally publishedYes

Fingerprint

Heart Transplantation
Bone and Bones
Calcitriol
Diphosphonates
Bone Resorption
Transplantation
Therapeutics
pamidronate
Vitamin D
Spine
Etidronic Acid
Rib Fractures
Calcium
Femur Neck
Hydroxyproline
Osteocalcin
Hip Fractures
Intravenous Infusions
Skeleton
Bone Density

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Shane, E., Rodino, M. A., McMahon, D. J., Addesso, V., Staron, R. B., Seibel, M. J., ... Sha Hwa Lo, H. L. (1998). Prevention of bone loss after heart transplantation with antiresorptive therapy: A pilot study. Journal of Heart and Lung Transplantation, 17(11), 1089-1096.

Prevention of bone loss after heart transplantation with antiresorptive therapy : A pilot study. / Shane, E.; Rodino, M. A.; McMahon, D. J.; Addesso, V.; Staron, R. B.; Seibel, M. J.; Mancini, D.; Michler, Robert E.; Sha Hwa Lo, Hwa Lo.

In: Journal of Heart and Lung Transplantation, Vol. 17, No. 11, 1998, p. 1089-1096.

Research output: Contribution to journalArticle

Shane, E, Rodino, MA, McMahon, DJ, Addesso, V, Staron, RB, Seibel, MJ, Mancini, D, Michler, RE & Sha Hwa Lo, HL 1998, 'Prevention of bone loss after heart transplantation with antiresorptive therapy: A pilot study', Journal of Heart and Lung Transplantation, vol. 17, no. 11, pp. 1089-1096.
Shane E, Rodino MA, McMahon DJ, Addesso V, Staron RB, Seibel MJ et al. Prevention of bone loss after heart transplantation with antiresorptive therapy: A pilot study. Journal of Heart and Lung Transplantation. 1998;17(11):1089-1096.
Shane, E. ; Rodino, M. A. ; McMahon, D. J. ; Addesso, V. ; Staron, R. B. ; Seibel, M. J. ; Mancini, D. ; Michler, Robert E. ; Sha Hwa Lo, Hwa Lo. / Prevention of bone loss after heart transplantation with antiresorptive therapy : A pilot study. In: Journal of Heart and Lung Transplantation. 1998 ; Vol. 17, No. 11. pp. 1089-1096.
@article{104a849bfe25469e9a209696e8ba3c82,
title = "Prevention of bone loss after heart transplantation with antiresorptive therapy: A pilot study",
abstract = "Background: Heart transplantation, with its attendant glucocorticoid and cyclosporine therapy, has deleterious effects on the skeleton. We have previously reported rapid bone loss and high fracture rates (36{\%} of patients) during the first year after heart transplantation. The bone loss was accompanied by declines in serum 1,25-dihydroxyvitamin D and osteocalcin levels and increased urinary excretion of markers of bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline). We therefore investigated whether bone loss could be prevented by bisphosphonates, agents that inhibit bone resorption. Methods: Serial measurements of bone mineral density (BMI) and biochemical indexes of mineral metabolism were compared in 18 group A patients who received a single intravenous infusion of pamidronate (60 mg) within 2 weeks of heart transplantation, followed by 4 cycles of oral etidronate (400 mg daily for 14 days every 3 months) and oral calcitriol 0.25 μg daily, to those of 52 patients who previously underwent transplantation (group B) who did not receive antiresorptive therapy. Both groups received elemental calcium 1000 mg and vitamin D 400 IU daily. Results: At 12 months after transplantation, there was virtually no lumbar spine bone loss in group A patients, whereas lumbar spine BMD had declined significantly in group B patients (0.2{\%} ± 0.9{\%} vs 6.8{\%} ± 1.0{\%}, respectively; P < .0001). Similarly, femoral neck BMD fell by 10.6{\%} ± 1.1{\%} in group B patients and by only 2.7{\%} ± 1.4{\%} in group A patients (P < .0001). Three incident vertebral fractures occurred in two group A patients, whereas 17 group B patients sustained 30 incident vertebral fractures, one hip fracture and three episodes of rib fractures (P < .02; test of proportions). With respect to markers of bone resorption, urinary deoxypyridinoline fell by 51{\%} ± 9{\%} in group A patients and increased by 65{\%} ± 22{\%} in group B patients by 3 months after transplantation (P < .0001). Conclusions: In summary, heart transplant recipients treated with bisphosphonates and replacement doses of calcitriol sustained less bone loss and fewer fractures than those treated with calcium and vitamin D. Wee conclude that bisphosphonate therapy, in conjunction with calcitriol, shows promise for prevention of transplantation-related osteoporosis.",
author = "E. Shane and Rodino, {M. A.} and McMahon, {D. J.} and V. Addesso and Staron, {R. B.} and Seibel, {M. J.} and D. Mancini and Michler, {Robert E.} and {Sha Hwa Lo}, {Hwa Lo}",
year = "1998",
language = "English (US)",
volume = "17",
pages = "1089--1096",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "11",

}

TY - JOUR

T1 - Prevention of bone loss after heart transplantation with antiresorptive therapy

T2 - A pilot study

AU - Shane, E.

AU - Rodino, M. A.

AU - McMahon, D. J.

AU - Addesso, V.

AU - Staron, R. B.

AU - Seibel, M. J.

AU - Mancini, D.

AU - Michler, Robert E.

AU - Sha Hwa Lo, Hwa Lo

PY - 1998

Y1 - 1998

N2 - Background: Heart transplantation, with its attendant glucocorticoid and cyclosporine therapy, has deleterious effects on the skeleton. We have previously reported rapid bone loss and high fracture rates (36% of patients) during the first year after heart transplantation. The bone loss was accompanied by declines in serum 1,25-dihydroxyvitamin D and osteocalcin levels and increased urinary excretion of markers of bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline). We therefore investigated whether bone loss could be prevented by bisphosphonates, agents that inhibit bone resorption. Methods: Serial measurements of bone mineral density (BMI) and biochemical indexes of mineral metabolism were compared in 18 group A patients who received a single intravenous infusion of pamidronate (60 mg) within 2 weeks of heart transplantation, followed by 4 cycles of oral etidronate (400 mg daily for 14 days every 3 months) and oral calcitriol 0.25 μg daily, to those of 52 patients who previously underwent transplantation (group B) who did not receive antiresorptive therapy. Both groups received elemental calcium 1000 mg and vitamin D 400 IU daily. Results: At 12 months after transplantation, there was virtually no lumbar spine bone loss in group A patients, whereas lumbar spine BMD had declined significantly in group B patients (0.2% ± 0.9% vs 6.8% ± 1.0%, respectively; P < .0001). Similarly, femoral neck BMD fell by 10.6% ± 1.1% in group B patients and by only 2.7% ± 1.4% in group A patients (P < .0001). Three incident vertebral fractures occurred in two group A patients, whereas 17 group B patients sustained 30 incident vertebral fractures, one hip fracture and three episodes of rib fractures (P < .02; test of proportions). With respect to markers of bone resorption, urinary deoxypyridinoline fell by 51% ± 9% in group A patients and increased by 65% ± 22% in group B patients by 3 months after transplantation (P < .0001). Conclusions: In summary, heart transplant recipients treated with bisphosphonates and replacement doses of calcitriol sustained less bone loss and fewer fractures than those treated with calcium and vitamin D. Wee conclude that bisphosphonate therapy, in conjunction with calcitriol, shows promise for prevention of transplantation-related osteoporosis.

AB - Background: Heart transplantation, with its attendant glucocorticoid and cyclosporine therapy, has deleterious effects on the skeleton. We have previously reported rapid bone loss and high fracture rates (36% of patients) during the first year after heart transplantation. The bone loss was accompanied by declines in serum 1,25-dihydroxyvitamin D and osteocalcin levels and increased urinary excretion of markers of bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline). We therefore investigated whether bone loss could be prevented by bisphosphonates, agents that inhibit bone resorption. Methods: Serial measurements of bone mineral density (BMI) and biochemical indexes of mineral metabolism were compared in 18 group A patients who received a single intravenous infusion of pamidronate (60 mg) within 2 weeks of heart transplantation, followed by 4 cycles of oral etidronate (400 mg daily for 14 days every 3 months) and oral calcitriol 0.25 μg daily, to those of 52 patients who previously underwent transplantation (group B) who did not receive antiresorptive therapy. Both groups received elemental calcium 1000 mg and vitamin D 400 IU daily. Results: At 12 months after transplantation, there was virtually no lumbar spine bone loss in group A patients, whereas lumbar spine BMD had declined significantly in group B patients (0.2% ± 0.9% vs 6.8% ± 1.0%, respectively; P < .0001). Similarly, femoral neck BMD fell by 10.6% ± 1.1% in group B patients and by only 2.7% ± 1.4% in group A patients (P < .0001). Three incident vertebral fractures occurred in two group A patients, whereas 17 group B patients sustained 30 incident vertebral fractures, one hip fracture and three episodes of rib fractures (P < .02; test of proportions). With respect to markers of bone resorption, urinary deoxypyridinoline fell by 51% ± 9% in group A patients and increased by 65% ± 22% in group B patients by 3 months after transplantation (P < .0001). Conclusions: In summary, heart transplant recipients treated with bisphosphonates and replacement doses of calcitriol sustained less bone loss and fewer fractures than those treated with calcium and vitamin D. Wee conclude that bisphosphonate therapy, in conjunction with calcitriol, shows promise for prevention of transplantation-related osteoporosis.

UR - http://www.scopus.com/inward/record.url?scp=0031764757&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031764757&partnerID=8YFLogxK

M3 - Article

VL - 17

SP - 1089

EP - 1096

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 11

ER -