Abstract
Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student’s t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (−0.020 ± 0.08 vs. −0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. −0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.
Highlights
The aim of this study was to investigate the effects of a moderate to high (≈2.6 g daily) supplement with marine n-3 PUFA on bone mass and mineral metabolism, as predefined secondary endpoints of a randomized, placebo-controlled trial in kidney transplant recipients.bone mineral density (BMD) determined at multiple sites, as well as trabecular bone score (TBS) of the lumbar spine, were included in the skeletal assessment
Biochemical markers of calcium metabolism. These were pre-specified, secondary endpoints of the Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial, and to our knowledge this is the first randomized, placebo-controlled trial to consider the effects of marine n-3 PUFA on bone disease and mineral metabolism after kidney transplantation
In our previous observational study, a positive correlation was found between plasma n-3 PUFA and total calcium levels in kidney transplant recipient, which might support a similar mechanism in humans [21]
Summary
Kidney transplant recipients are at high risk of fracture in the years following kidney transplantation [1,2,3]. N-3 PUFA may have beneficial effects in bone [11], as in vivo studies have demonstrated inhibition of osteoclasts [12,13], and stimulation of osteoblasts [14], which could potentially translate into reduced bone resorption and increased bone mineralization. High levels of plasma marine n-3 PUFA was associated with higher bone mineral density (BMD) [15,16] and a reduced risk of fractures [17]. Increased hip BMD was seen in elderly women treated for 18 months with 6 g of mixed oils, of which 420 mg were marine n-3
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