Treatment with vitamin D and calcium reduces bone loss after renal transplantation:: A randomized study

A decrease in bone mineral density (BMD) is a major complication of renal transplantation (RTx), predominantly Occurring within the first 6 mo after RTx. The most important causative factor is the use of corticosteroids. but persisting hyperparathyroidism and abnormalities in vitamin D metabolism play a role too, This study examines the effect of treatment with calcium and active vitamin D on the loss of BMD in the first 6 mo after RTx. A total of 111 renal transplant recipients (65 men. 46 women: age, 47 +/- 13 yr) were randomized to either treatment with active vitamin D (0.25 mug/d) plus calcium (1000 mg/d) (CaD group). Or to no treatment (NOT group). Immunosuppressive therapy consisted of cyclosporine. prednisone. and mycophenolate mofetil. Laboratory parameters and BMD (lumbar spine and hip) were measured at 0.1 (laboratory only). 3. and 6 mo after RTx. Lumbar BMD was nearly normal at the time of RTx. In both groups. a significant decrease m lumbar BMD was observed during the first 3 mo (CaD, -3.3 +/- 4.3%: P < 0.0001: NOT, -4.1 +/- 4.8% P < 0,000 1). Between the third clay and sixth month, lumbar BNID slightly recovered in the CaD group, but it decreased further in the NOT group (total loss 0 to 6 mo: CaD. -2.6 +/- 5.0% [P < 0.001]: NOT. -5.0 +/- 4.7% [P < 0.0001]). As a result, the amount of bone loss at 6 trio was significantly lower in the CaD group (P = 0.02). Loss of BMD at the different femoral sites was also significantly reduced in the CaD group. Apart from a trend toward more frequent hypercalcemia in the CaD group. no clinical or biochemical differences existed between the groups. Treatment with a low dose of active vitamin D and calcium partially prevents bone loss at the lumbar spine and proximal femur during the first 6 mo after RTx.