Weekly oral bisphosphonates over 2 years prevent bone loss in cardiac transplant patients.

Abstract

Heart transplantation (HTX) is an established therapy for end-stage heart disease. The aim of this study was to determine whether application of oral bisphosphonates is effective in preventing osseous complications after HTX. Thirty-three cardiac transplant recipients were treated with alendronate 70mg/wk or risedronate 35mg/wk in combination with 1000mg calcium and 800IU vitamin D. Markers of bone metabolism and dual-energy X-ray absorptiometry (DXA) were determined directly after HTX and 2years later. Primary endpoints were changes in bone mineral density (BMD), markers of bone metabolism (osteocalcin, crosslaps), serum levels of the cytokines osteoprotegerin (OPG), receptor activator of NF kappa-B ligand (RANKL), and incidence of fractures. Eight patients presented with osteoporosis, and 16 patients with osteopenia by DXA without prevalent fractures. Over 2years, the BMD improved in 2 patients from osteoporosis to osteopenia, and overall BMD remained stable, and fractures did not occur. In addition, the serum levels of OPG increased (P<.0005), and the RANKL levels (P<.001) as well as the RANKL/OPG-ratio decreased significantly (P<.0005). The serum crosslaps showed no significant changes. The BMD showed a significant association with the increased 25-vitamin D levels only in females (P<.001). In heart transplanted patients, weekly oral bisphosphonates in combination with calcium and vitamin D supplementation preserved bone mass, prevented uncoupling of bone resorption/formation and fractures. Bone density should be measured and adequately treated, that is, with regular bisphosphonates.