Bone mineral density in lung-transplant recipients before and after graft:Prevention of lumbar spine post-transplantation-accelerated bone loss by pamidronate

Background: Lung-transplant recipients are at risk of osteoporosis. They ma y have low bone mass even before posttransplantation immunosuppressive ther apy. We studied bone mineral density (BMD) before and after lung transplant ation and compared the efficacy of antiresorptive therapies to calcium and vitamin D supplementation. Methods: Areal BMD was assessed in 42 patients awaiting lung transplantatio n and measured again after surgery at 6 (n = 29), and at 12 months (n = 20) . Nineteen patients received antiresorptive therapy (30 mg pamidronate IV e very 3 months (n = 14), or hormonal replacement therapy (n = 5)), and 10 pa tients received only calcium and vitamin D supplements. Results: Mean age- and gender-adjusted lumbar spine (LS) and femoral neck ( FN) BMD was significantly decreased prior to transplantation (- 0.6 +/- 0.2 , p < 0.01, and - 2.5 +/- 0.2 standard deviation, p < 0.001, respectively). At that time, 29% were osteoporotic (T-score < - 2.5 below the peak bone m ass), while 55% were below - 1.0 T-score. Antiresorptive therapy decreased the rate of LS bone loss during the first 6 months and led to a significant increase of BMD at 1 year, with LS changes of + 0.2 +/- 0.1 vs - 0.4 +/- 0 .1 Z-score in the calcium-vitamin D group (p < 0.002), and + 0.2 +/- 0.1 vs - 0.04 1 0.1 for FN (NS). One out of 20 patients experienced clinically ev ident fractures during antiresorptive therapy, and 3 out of 12 in the calci um-vitamin D group. Conclusion: A significant proportion of patients awaiting lung transplantat ion was osteoporotic or osteopenic. Antiresorptive therapy (pamidronate or hormone-replacement therapy (HRT)) prevented accelerated LS bone loss after graft.