Fan S, Almond MK Ball E, Evand K, Cunningham J
Randomised prospective study demonstrating prevention of bone loss by
pamidronate during the first year after renal transplantation
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1789 1996
Fractures are one of the major complications of all solid organ
transplants. Whether due to steroids, other immunosuppressives,
pre-existing disease, or (most likely) a combination of all of these,
for the patient fractures seriously compromise rehabilitation and
quality of life. Major efforts are currently being directed at this
problem, particularly in heart and kidney recipients.
Because most investigators feel that bone loss in this setting results
from a dissociation of bone formation and resorption, attempts are
directed at either enhancing bone formation or inhibiting bone
resorption. Since we are better at the latter than the former, current
studies are largely aimed at inhibiting bone resorption. Pamidronate, a
bisphosphonate, is a potent inhibitor of resorption and was recently
described to reduce bone loss in a cardiac transplant population.
These authors studied 28 patients (16 controls and 12 treatment
subjects). They measured bone density at the spine and hip at the time
of renal transplant and 3 and 12 months later. They administered
pamidronate intravenously at the time of tranplant and one month
later. Bone loss was markedly attenuated at the spine and prevented at
the femoral neck by this therapy. No side effects of the treatment were
seen.
Comment: This is an exciting report which offers hope for a serious
problem most
of us confront frequently. Several other ongoing studies using
different bisphosphonates will hopefully confirm these findings. One
wonders if in the future some combination of therapy might be useful.
One scenario might be to use pamidronate intravenously early on (to
prevent the early severe bone loss) and follow this with oral
alendronate to prevent the later loss which seems to occur almost
inevitably with nearly any dose of steroids.
(Donald Sherrard, M.D., University of Washington)
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Am Soc Nephrol
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