Prevention of bone loss in renal transplant recipients: A prospective, randomized trial of intravenous pamidronate
Prevention of bone loss in renal transplant recipients: A prospective, randomized trial of intravenous pamidronate
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DOI：
10.1097/01.asn.0000087092.53894.80
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发表时间：
2003-10-01
影响因子：
13.6
通讯作者：
Malluche, H
中科院分区：
文献类型：
--
作者：
Coco, M;Glicklich, D;Malluche, H
肾移植受者有发生骨异常的风险，这会导致骨丢失和骨折。这些与潜在的肾性骨营养不良、低磷血症和免疫抑制治疗方案有关。虽然双膦酸盐在改善移植后的骨矿物质丢失方面是有效的，但目前还不知道它们在肾移植患者中的使用是否会导致过度的骨转换抑制和增加动态骨病的发生率。一项随机、前瞻性、对照的临床试验被用于新肾移植患者的静脉注射双膦酸帕米磷酸酯。治疗对象(PAM)在基线、1、2、3和6个月时接受含有维生素D和钙的帕米磷酸钠治疗。对照组(CON)仅接受维生素D和钙治疗。在6个月到12个月期间，受试者在没有接受帕米磷酸钠治疗的情况下进行观察。在基线、6个月和12个月获取骨转换的生化参数，并获取骨密度(BMD)。接受定期活体供体移植的受试者在基线和6个月进行骨组织学矿化活组织学检查。用骨密度计量学和组织形态计量学测量PAM在6个月和12个月时保存的骨量。CON治疗后6mo和12mo椎体骨密度下降，分别为4.8±0.08和6.1±0.09%。6个月和12个月时两组的骨转换生化指标相似。骨组织学显示50%的患者在基线时有低周转率的骨病。在6个月时，所有的PAM都有动态的骨病，而50%的CON继续或发展为骨转换降低。帕米磷酸钠在治疗过程中和停药后6个月保存椎体骨密度。帕米磷酸钠治疗与动态骨组织学的发展有关。改善的骨密度和动态的骨组织学是否有助于维持肾移植受者的长期骨健康还有待进一步研究。
Renal transplant recipients are at risk of developing bone abnormalities that result in bone loss and bone fractures. These are related to underlying renal osteodystrophy, hypophosphatemia, and immunosuppressive treatment regimen. Although bisphosphonates are useful in ameliorating bone mineral loss after transplantation, it is not known whether their use in renal transplant patients leads to excessive suppression of bone turnover and increased incidence of adynamic bone disease. A randomized, prospective, controlled, clinical trial was conducted using the bisphosphonate pamidronate intravenously in patients with new renal transplants. Treatment subjects (PAM) received pamidronate with vitamin D and calcium at baseline and at months 1, 2, 3, and 6. Control (CON) subjects received vitamin D and calcium only. During months 6 to 12, the subjects were observed without pamidronate treatment. Biochemical parameters of bone turnover were obtained monthly and, bone mineral density (BMD) was obtained at baseline and months 6 and 12. Bone biopsies for mineralized bone histology were obtained at baseline and at 6 mo in a subgroup of subjects who underwent scheduled living donor transplantation. PAM preserved bone mass at 6 and 12 mo as measured by bone densitometry and histomorphometry. CON had decreased vertebral BMD at 6 and 12 mo (4.8 +/- 0.08 and 6.1 +/- 0.09%, respectively). Biochemical parameters of bone turnover were similar in both groups at 6 and 12 mo. Bone histology revealed low turnover bone disease in 50% of the patients at baseline. At 6 mo, all of PAM had adynamic bone disease, whereas 50% of CON continued to have or developed decreased bone turnover. Pamidronate preserved vertebral BMD during treatment and 6 mo after cessation of treatment. Pamidronate treatment was associated with development of adynamic bone histology. Whether an improved BMD with adynamic bone histology is useful in maintaining long-term bone health in renal transplant recipients requires further study.