A prospective study of bone loss and turnover after cardiac transplantation : Effect of calcium supplementation with or without calcitonin

• Published in: Osteoporosis international 1999-08, Vol.10 (2), p.128-136
• Main Authors: VÄLIMÄKI, M. J, KINNUNEN, K, TÄHTELÄ, R, LÖYTTYNIEMI, E, LAITINEN, K, MÄKELÄ, P, KETO, P, NIEMINEN, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Bone density; Bone Density - drug effects; Bone Density - physiology; Bone Resorption - physiopathology; Bone Resorption - prevention & control; Calcitonin - pharmacology; Calcium - pharmacology; Drug dosages; Female; Fractures; Fundamental and applied biological sciences. Psychology; Heart Transplantation - physiology; Heart transplants; Humans; Male; Medical sciences; Middle Aged; Osteoporosis; Prospective Studies; Skeleton and joints; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Vertebrates: osteoarticular system, musculoskeletal system
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s001980050207

Cardiac transplantation exposes recipients to osteoporosis and increased risk of consequent fractures. The purpose of the present study was to examine the magnitude, timing and mechanism of bone loss following cardiac transplantation, and to establish whether bone loss can be prevented by calcium with or without calcitonin. Thirty patients (29 men, 1 woman), aged 26-68 years (mean 48 years), were randomized into three groups of 10 to receive either no additional treatment, oral calcium 1 g twice daily for 12 months or the same dose of calcium plus intranasal calcitonin 400 IU/day for the first month and then 200 IU/day for 11 months. Bone mineral density (BMD) at the lumbar spine and three femoral sites (femoral neck, trochanter, Ward's triangle) was measured by dual-energy X-ray absorptiometry (DXA) at the time of transplantation and 6 and 12 months later. Markers of bone formation [serum bone-specific alkaline phosphatase (B-ALP), type I procollagen carboxyterminal propeptide (PICP) and aminoterminal propeptide (PINP)] and resorption [serum type I collagen carboxyterminal telopeptide (ICTP)], as well as serum testosterone in men, were assayed before transplantation and at 1 week and 1, 3, 6 and 12 months after transplantation. During the first 6 post-transplant months BMD calculated as a percent change from baseline decreased in the control group by 6.4% (p = 0.014) in the lumbar spine, by 6.0% (p = 0.003) in the femoral neck, by 5.0% (p = 0.003) in the trochanter and by 5.5% (p = 0.130) in Ward's triangle. Between 6 and 12 months a further decline in BMD occurred only at the three femoral sites, ranging from 2.2% to 9.8% (p = 0.004-0.079). In comparison with the control group, the group receiving calcium alone lost less bone in the trochanter between 0 and 6 months (p = 0.019), and the group receiving calcium together with calcitonin lost less bone in the femoral neck (p = 0.068) and Ward's triangle (p = 0.076) between 0 and 12 months. Seven (28%) of 25 assessable patients experienced vertebral compression fractures. Calcium with or without calcitonin had no effect on changes in biochemical parameters; consequently, the three study groups were combined. The markers of bone formation increased, the elevations in mean values being 59% for B-ALP at 1 month (p = 0.009), 152% for PICP at 1 week (p < 0. 0001) and 27% for PINP at 1 week (p = 0.021). After a temporary decline at 3 months B-ALP (p = 0.0002) and PINP (p < 0.0001) at 1 year were nearly doubled com