Efficacy of Long-term Alendronate Treatment to Treat Bone Mineral Disorders in Renal Transplant
Introduction
In end stage renal disease (ESRD) patients, bone mineral disorders are common. Even after a successful renal transplant, osteopenia and osteoporosis remain prevalent. Renal transplant recipients usually have low vitamin D levels and calcium and phosphorus deficiency. Bone mineral density (BMD) loss, which increases the mortality rate in kidney transplant recipients in the long term, may develop despite calcium and vitamin D replacement. Treatment of post-transplant bone mineral disorders includes phosphorus, calcium, vitamin D supplementations, calcimimetics, anabolic and antiresorptive agents such as bisphosphonates.
Aim
To evaluate the effects of long-term administration of alendronate sodium for treating bone loss in renal transplant recipients (RTRs).
Patient Profile
Renal transplant recipients who had received 3 consecutive BMD measurements and received the same treatment for at least 2 years.
Methods
- All patients were divided into 3 groups.
- Efficacy of alendronate was determined by comparing sociodemographic data such as age, sex, body mass index (BMI), transplantation follow-up time and baseline, 12- and 24-month biochemical parameters (serum creatinine, calcium Ca2+], phosphorus [P], parathyroid hormone [PTH], and 25-OH vitamin D levels [25(OH) vitamin D]), and BMD measurements between groups.
Results
- Femoral neck and lumbar spine BMD were stable in patients who received alendronate, calcium, and vitamin D3 (Group 1) at the end of the first year.
- In Group 1, significant improvement in the lumbar spine and femoral neck BMD were seen at the end of the second year.
- No improvement in BMD levels was observed in Groups 2 and 3.
Table 1 : Lumbar Spine and Femoral Neck Bone Mineral Density Measurements
|
Parameter |
|
Group 1 (n = 28) |
Group 2 (n = 31) |
Group 3 (n = 23) |
p |
|
Lumbar (L1-L5) T score |
Baseline |
−2.12 + 0.88 |
−0.71 + 0.87 |
−0.35 + 1.2 |
<.001 |
|
|
1 y |
−2.04 + 0.98 |
−0.65 + 0.94 |
−0.06 + 1.4 |
<.001 |
|
|
2 y |
−1.91 + 1.08 |
−0.72 + 1.0 |
−0.04 + 1.5 |
<.001 |
|
Femoral neck T score |
Baseline |
−2.0 + 0.56 |
−0.71 + 1.0 |
−0.35 + 1.0 |
<.001 |
|
|
1 y |
−1.9 + 0.5 |
−0.72 + 1.3 |
−0.26 + 1.1 |
<.001 |
|
|
2 y |
−1.74 + 0.6 |
−0.66 + 1.3 |
−0.20 + 1.6 |
<.001 |
|
Lumbar spine (g/cm2) |
Baseline |
0.892 + 0.12 |
1.020 + 0.14 |
1.104 + 0.16 |
<.001 |
|
|
1 y |
0.886 + 0.12 |
1.034 +0.14 |
1.135 + 0.17 |
<.001 |
|
|
2 y |
0.901 + 0.14 |
1.025 + 0.12 |
1.145 + 0.17 |
<.001 |
|
Femur neck (g/cm2) |
Baseline |
0.761 + 0.11 |
0.884 + 0.15 |
0.977 + 0.17 |
<.001 |
|
|
1 y |
0.758 + 0.09 |
0.866 + 0.17 |
0.977 + 0.16 |
<.001 |
|
|
2 y |
0.781 + 0.10 |
0.887 + 0.18 |
0.975 + 0.22 |
.002 |
- Correlation analysis showed
- Negative correlation between the baseline femoral neck T score and female sex, baseline PTH and BMI and
- Positive correlation between baseline femoral neck T score and creatinine level in Group 1 patients.
- Basal BMI & femoral neck BMD in Group 2 showed a positive correlation
- No correlation between baseline parameters, demographic data, and BMDwas seen in group 3 patients
Conclusion
- In renal transplant patients, addition of alendronate to treatment stops bone loss. When continued for a long term it may reverse BMD loss.
Reference
Transplantation Proceedings. 2022; 54: 658- 662
