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A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation.

Authors
  • Marques, Igor Denizarde Bacelar1
  • Araújo, Maria Júlia Correia Lima Nepomuc...1, 2
  • Graciolli, Fabiana Giorgetti2
  • Dos Reis, Luciene Machado2
  • Pereira, Rosa Maria R3
  • Alvarenga, Jackeline C3
  • Custódio, Melani Ribeiro1, 2
  • Jorgetti, Vanda2
  • Elias, Rosilene Motta2
  • Moysés, Rosa Maria Affonso2
  • David-Neto, Elias4, 2
  • 1 Urology Division, Renal Transplant Service and.
  • 2 Nephrology and.
  • 3 Rheumatology Divisions, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. , (Brazil)
  • 4 Urology Division, Renal Transplant Service and [email protected]
Type
Published Article
Journal
Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Feb 01, 2019
Volume
30
Issue
2
Pages
355–365
Identifiers
DOI: 10.1681/ASN.2018060656
PMID: 30606784
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Bone and mineral disorders commonly affect kidney transplant (KTx) recipients and have been associated with a high risk of fracture. Bisphosphonates may prevent or treat bone loss in such patients, but there is concern that these drugs might induce adynamic bone disease (ABD). In an open label, randomized trial to assess the safety and efficacy of zoledronate for preventing bone loss in the first year after kidney transplant, we randomized 34 patients before transplant to receive zoledronate or no treatment. We used dual-energy x-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and bone biopsies to evaluate changes in bone in the 32 evaluable participants between the time of KTx and 12 months post-transplant. Both groups of patients experienced decreased bone turnover after KTx, but zoledronate itself did not affect this outcome. Unlike previous studies, DXA showed no post-transplant bone loss in either group; we instead observed an increase of bone mineral density in both lumbar spine and total hip sites, with a significant positive effect of zoledronate. However, bone biopsies showed post-transplant impairment of trabecular connectivity (and no benefit from zoledronate); HR-pQCT detected trabecular bone loss at the peripheral skeleton, which zoledronate partially attenuated. Current immunosuppressive regimens do not contribute to post-transplant central skeleton trabecular bone loss, and zoledronate does not induce ABD. Because fractures in transplant recipients are most commonly peripheral fractures, clinicians should consider bisphosphonate use in patients at high fracture risk who have evidence of significantly low bone mass at these sites at the time of KTx. Copyright © 2019 by the American Society of Nephrology.

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