Effect of ibandronate on bone loss and renal function after kidney transplantation

Severe osteoporosis frequently is observed after organ transplantation. In kidney transplantation, it adds to preexisting renal bone disease and strat egies to prevent osteoporosis are not established. Eighty kidney recipients were included in a randomized controlled prospective intervention trial. T reated patients (n = 40) received an injection of ibandronate, a bisphospho nate, immediately before and at 3, 6, and 9 mo after transplantation. The p rimary outcome measured was the change in bone mineral density. Secondary m easures included graft outcome, spinal deformities, fracture rate, body hei ght, and hormonal and metabolic data. Loss of spongy and cortical bone afte r transplantation was prevented by ibandronate. Changes of bone mineral den sity (ibandronate versus controls) were as follows: lumbar spine, -0.9 +/- 6.1% versus -6.5 +/- 5.4% (p < 0.0001); femoral neck, +0.5 +/- 5.2% versus -7.7 +/- 6.5% (P < 0.0001); and midfemoral shaft, +2.7 +/- 12.2% versus -4. 0 +/- 10.9% (P = 0.024). Fewer spinal deformities developed with ibandronat e (7 patients with 7 deformities versus 12 patients with 23 deformities; P = 0.047). Loss of body height was 0.5 +/- 1.0 cm versus 1.1 +/- 1.0 cm in c ontrol subjects (P = 0.040). Two bone fractures occurred in each group. The re were fewer acute rejection episodes with ibandronate (11 versus 22; P = 0.009). Graft function after 1 yr was comparable. Bone loss, spinal deforma tion, and loss of body height during the First year after kidney transplant ation are prevented by injection of ibandronate at intervals of 3 mo. The s maller number of rejection episodes of the ibandronate-treated group should be confirmed and its mechanism should be explored in additional studies.