J Clin Endocrinol Metab. 2011 Aug 17.
Stein EM, Ortiz D, Jin Z, McMahon DJ, Shane E.
Division of Endocrinology (E.M.S., D.O., D.J.M.,E.S.), Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032; and Department of Biostatistics (Z.J.), Mailman School of Public Health, Columbia University, New York, New York 10032.
Context: Bone loss and fracture are serious sequelae of organ transplantation, particularly in the first posttransplant year.
Most interventional studies have been inadequately powered to detect effects on fracture.
Objective: The objective of the study was to determine whether treatment with bisphosphonates (BP) or active vitamin D analogs (vitD) during the first year after transplantation reduces fracture risk and estimate the effect of these interventions on bone loss.
Data Sources: Sources included PUBMED, MEDLINE, Cochrane Library, and abstracts from scientific meetings (presented 2003-2010).
Study Selection: Randomized controlled clinical trials of BP or vitD in solid organ transplant recipients were included if treatment was initiated at the time of transplantation and fracture data were collected.
Data Extraction: Two investigators independently extracted data and rated study quality.
Fixed effect and random-effects models were used to obtain pooled estimates.
Data Synthesis: Eleven studies of 780 transplant recipients (134 fractures) were included.
Treatment with BP or vitD reduced the number of subjects with fracture [odds ratio (OR) 0.50 (0.29, 0.83)] and number of vertebral fractures, [OR 0.24 (0.07, 0.78)]. An increase in bone mineral density at the lumbar spine [2.98% (1.31, 4.64)] and femoral neck [3.05% (2.16, 3.93)] was found with treatment. When BP trials (nine studies, 625 subjects) were examined separately, there was a reduction in number of subjects with fractures [OR 0.53 (0.30, 0.91)] but no significant reduction in vertebral fractures [OR 0.34 (0.09, 1.24)].
Conclusions: Treatment with BP or vitD during the first year after solid organ transplant was associated with a reduction in the number of subjects with fractures and fewer vertebral fractures.
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Doctors Channel has a video and the following
NEW YORK (Reuters Health) – The high risk of fractures in the first year after solid organ transplantation can be roughly halved with bisphosphonate or vitamin D treatment, according to the results of a meta-analysis reported in the Journal of Clinical Endocrinology and Metabolism published online August 17.
“With treatment, the total number of subjects with fractures, the absolute number of fractures, and number of vertebral fractures were all significantly reduced,” the authors conclude.
Dr. Elizabeth Shane and colleagues at Columbia University College of Physicians and Surgeons in New York, New York note that fracture rates as high as 37% have been reported in the first year after transplantation, and are associated with mortality, significant morbidity, and reduced quality of life.
Numerous randomized clinical trials, they point out, have shown that treatment with bisphosphonates or active metabolites of vitamin D after transplant prevents bone loss during the first year, but differences in fracture rates among treated and untreated patients have not been clear.
The researchers therefore conducted a meta-analysis of 11 studies with a total of 780 participants who experienced a total of 134 fractures in the first year after transplantation. Nine of the trials compared a bisphosphonate with a placebo or no treatment, and two trials compared 1-alpha-hydroxyvitamin D or calcitriol with no treatment.
Treatment reduced the number of patients with fractures (odds ratio 0.50) as well as the number of vertebral fractures (OR 0.24), the results indicated.
Analysis of just the bisphosphonate trials showed that the number of fractures was reduced to a similar degree (OR 0.53), but the reduction in vertebral fractures was not significant.
Dr. Shane and colleagues point out that “none of the studies used tacrolimus, which might be associated with less bone loss than cyclosporine and thus could also be associated with lower fracture risk.”
That said, they conclude, “In patients managed with glucocorticoids and cyclosporine A, treatment with bisphosphonates or active vitamin D analogs prevents fractures during the first year after organ transplantation.”
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Note: This study used the active form of vitamin D only (calcitriol ) available by prescription, not vitamin D3.
The active form does not need processing by the liver
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