Progression of steroid-associated osteoporosis after heart transplantation

Background. Osteoporosis has been recognized as an important side effect of long-term and of pulsed steroid application after heart transplantation. Methods. In June 1989 a prospective clinical trial was started to study bon e demineralization by quantitative computed tomographic scan. All patients received vitamin D and calcium. In group I (n = 30) synthetic calcitonin (4 0 Medical Research Council Standard Units subcutaneously per day was admini stered in 14-day cycles, whereas group II patients (n = 31) received a plac ebo preparation. Repeat trabecular and cortical quantitative computed tomog raphic scans of the thoracic (T12) and lumbar spine (L1, L2, L3) were obtai ned within 48 weeks after heart transplantation. Results. Expressed as the means of T12, L1, L2, and L3, trabecular bone den sity decreased significantly from 100 +/- 24 to 79 +/- 29 mg/mL within 3 we eks after heart transplantation, followed by a further reduction to 67 +/- 29 mg/mL after 3 months in the calcitonin group. The values for cortical bo ne density decreased significantly from 229 +/- 37 to 202 +/- 40 mg/mL (cal citonin) 3 weeks after heart transplantation. Comparable results were obtai ned in the placebo group. In both groups bone density remained stable there after. Intergroup differences were not of statistical significance. Conclusions. In heart transplant recipients progressive trabecular bone dem ineralization is limited to the first 3 postoperative months. Thereafter, b one density remained stable. A positive effect of synthetic calcitonin in a ddition to prophylactic calcium and vitamin D application could not be prov ed by repeat quantitative computed tomography. (C) 1999 by The Society of T horacic Surgeons.