Abstract
The aim of this observational study was to compare the effect of calcium and alfacalcidol supplementation on the regression of hyperparathyroidism and on prevention of osteopenia in patients up to 3 years after renal transplantation. Two historical cohorts were compared for that purpose. One hundred and fifty-nine patients received calcium carbonate supplement (group 1), while 81 patients were treated with alfacalcidol (group 2). Serum Ca, phosphate (P), Mg, creatinine, alkaline phosphatase (AP) and parathyroid hormone (PTH) levels were determined before and after transplantation in the two groups, for 3 years. Femoral neck and lumbar spine bone mineral density (BMD) was measured only at 3 and 6 months and 1, 2 and 3 years after transplantation. At baseline there was no difference in age or sex ratio, but prevalence in post-menopausal women was higher in group 1 (6.9% versus 1.2%). Duration on dialysis was comparable but prevalence of interstitial and undetermined nephropathies was higher in group 1. Baseline serum concentrations of PTH, Ca and P were comparable in both groups. After transplantation, plasma creatinine decreased to comparable levels in both groups. Immunosuppression by triple therapy was more prevalent in group 2, so that cumulative dose of steroid was higher in group 1, especially at 1 month because of higher incidence of acute rejections (51% versus 13%). Mean intact PTH levels decreased in both groups, from 18 pmol/l to 8.4 and 7.9 at 3 years, but the decrease was significantly greater with alfacalcidol at 6 and 12 months. At 3 months, BMD were comparable at both sites. From 3 months to 3 years after kidney transplantation, mean lumbar spine BMD significantly increased from 0.963 to 1.054 g/cm2 in group 1, whereas there was no significant decrease (1.048 to 1.006 g/cm2) in group 2, the difference in changes being significant (P<0.05). Femoral neck BMD was not significantly increased in either group (0.932 to 0.993 g/cm2 in group 1, and 0.850 to 0.907 g/cm2 in group 2). Expressed as percentages, these changes were +9.4% and –4% for lumbar BMD and +6.5% and +6.7% for femoral neck, for groups 1 and 2, respectively. Prevalence of osteopenia was not significantly lower at 3 years in group 1 (45% and 51%) than in group 2. During the follow-up period, osteonecrosis was diagnosed in six patients (3.8%) in group 1 and in nine (11%) in group 2. In conclusion, alfacalcidol compared to CaCO3 supplement suppressed hyperparathyroidism more rapidly and strongly. In spite of higher osteopenia risk in the CaCO3 group, lumbar BMD increase was greater and incidence of osteonecrosis higher in this group, suggesting better bone protection with CaCO3 than with alfacalcidol.
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Almond MK, Kwan JTC, Evans K, Cunningham J (1994) Loss of regional bone mineral density in the first 12 months following renal transplantation. Nephron 66:52–57
Babarykin D, Adamsone I, Amerika D, Folkmane I, Rozental R (1999) Disorders of calcium metabolism at various times after renal transplantation. Ann Transplant 4:46–53
Carlini RG, Rojas E, Weisinger JR, Lopez M, Martinis R, Arminio A, Bellorin-Font E (2000) Bone disease in patients with long-term renal transplantation and normal renal function. Am J Kidney Dis 36:160–166
Cueto-Manzano AM, Konel S, Huchinson AJ, Crowley V, France MW, Freemont AJ, Adams JE, Mawer B, Gokal R (1999) Bone loss in long-term renal transplantation: histopathology and densitometry analysis. Kidney Int 55:2021–2029
Monier-Faugere MC, Mawad H, Qi Q, Friedler RM, Malluche HH (2000) High prevalence of low bone turnover and occurrence of osteomalacia after kidney transplantation. J Am Soc Nephrol 11:1093–1099
Pichette V, Bonnerdeaux A, Prudhomme L, Gagne M, Cardinal J, Quimet D (1996) Long-term bone loss in kidney transplant recipients. A cross-sectional and longitudinal study. Am J Kidney Dis 28:105–114
Julian BA, Laskow DA, Dubovsky J, Dubovsky EV, Curtis JJ, Quarles LD (1991) Rapid loss of vertebral mineral density after renal transplantation. N Engl J Med 325:544–550
Torres A, Rodriguez AP, Conception MT, Garcia S, Rufino M, Martin B, Perez L, Machado M, Bonis E, Losada M, Hernandez D, Lorenzo V (1998) Parathyroid function in long-term renal transplant patients: importance of pre-transplant PTH concentrations. Nephrol Dial Transplant 13:94–97
Grotz WH, Mundinger FA, Gugel B, Exner VM, Kirste G, Schollmeyer PJ (1995) Bone mineral density after kidney transplantation. A cross-sectional study in 190 graft recipients up to 20 years after transplantation. Transplantation 59:982–986
Horber FF, Casez JP, Steiger U, Czerniak A, Montandon A, Jaeger PH (1994) Changes in bone mass early after kidney transplantation. J Bone Miner Res 9:1-9
Westeel FP, Mazouz H, Ezaitouni F, Hottelart C, Ivan C, Fardellone P, Brazier M, El-Esper I, Petit J, Achard JM, Pruna A, Fournier A (2000) Cyclosporine bone remodelling effect prevents steroid osteopenia after kidney transplantation. Kidney Int 58:1788–1796
Goffin E, Devogelaer JP, Depresseux G, van-Ypersele-de-Strihou C (2001) Bone mass evolution after renal transplantation. Kidney Int 59:1594–1595
Pazianas M, Phillips ME, MacRae KD, Eastwood JB (1992) Identification of risk factors for radiographic hyperparathyroidism in 422 patients with end-stage renal disease: development of a clinical predictive index. Nephrol Dial Transplant 7:1098–1105
Shiraishi A, Higashi S, Ohkawa H, Kubodera N, Hirasawa T, Ezawa I, Ikeda K, Ogata E (1999) The advantage of alfacalcidol over vitamin D in the treatment of osteoporosis. Calcif Tissue Int 65:311–316
Fujita T (1992) Vitamin D in the treatment of osteoporosis. Proc Soc Exp Biol Med 199:394–399
Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 327:1637–1642
Balsan S, Garabedian M, Larchet M, Gorski AM, Cournot G, Tau C, Bourdeau A, Silve C, Ricour C (1986) Long-term nocturnal calcium infusion can cure rickets and promote normal mineralization in hereditary resistance to 1,25-dihydroxyvitamin D. J Clin Invest 77:1661–1667
Li YC, Amling M, Pirro AE, Priemel M, Meuse J, Baron R, Delling MB (1998) Normalization of mineral ion homeostasis by dietary means prevents hyperparathyroidism, rickets, and osteomalacia, but not alopecia in vitamin D receptor-ablated mice. Endocrinology 139:4391–4396
Kinuta K, Tanaka H, Shinohara M, Kato S, Seino Y (2000) Vitamin D is a negative regulating factor in bone mineralization. J Bone Miner Res 15: S180
Fournier A, Bordier P, Gueris J, Sebert JL, Marie P, Ferriere C, Bedrossian J, De Luca HF (1979) Comparison of alpha-hydroxycholecalciferol and 25-hydroxycholecalciferol in the treatment of renal osteodystrophy: greater effect of 25-hydroxycholecalciferol on bone mineralization. Kidney Int 15:196–204
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Berczi, C., Asztalos, L., Kincses, Z. et al. Comparison of calcium and alfacalcidol supplement in the prevention of osteopenia after kidney transplantation. Osteoporos Int 14, 412–417 (2003). https://doi.org/10.1007/s00198-003-1389-0
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DOI: https://doi.org/10.1007/s00198-003-1389-0