CALCITONIN, ETIDRONATE, AND CALCIDIOL TREATMENT IN BONE LOSS AFTER CARDIAC TRANSPLANTATION

Cardiac transplantation is associated with severe bone loss caused by glucocorticoids, immunosuppressive treatment, and other factors. Treat ment protocols for the prevention of bone loss is being studied. Forty patients who underwent cardiac transplantation were randomly given ca lcitonin (n = 13; 100 UI/d, nasal route), etidronate(n = 14; cyclical treatment 400 mg p.o./d/2 weeks/3 months), or calcidiol (n = 13; 32,00 0 IU/weekly) therapy for at least 18 months. Serum parameters (Ca, P, alkaline phosphatase, osteocalcin, intact PTH), urinary calcium, and v ertebral mineral density (VMD; L2-L4, DXA Hologic QDR 1000) were measu red immediately before treatment and after 6, 12, and 18 months of the rapy after cardiac transplantation. Patients with cardiac transplantat ion had a VMD significantly lower than age and sex-matched Spanish con trols, Prevalence of osteoporosis (Z-score below -2 SD) was 30%. Osteo calcin levels increased at 6, 12, and 18 months of treatment in the th ree groups. After 18 months of treatment, VMD increased significantly in the calcidiol 4.9%, vs. -1.19% and -0.19% in the calcitonin and eti dronate groups, respectively. A lower incidence of fracture was found in patients treated with calcidiol during the study. In summary, we ha ve found in this open randomized study that calcidiol was the most eff ective drug in the prevention and treatment of bone loss in patients a fter cardiac transplantation.