Transplant Bone Disease Clinical Trial
Official title:
Pamidronate, Vitamin D, and Calcium for the Bone Disease of Kidney and Heart Transplantation
Bone is lost rapidly and fractures occur in 10-20% of patients who receive organ transplants within 2 years. The purpose of this study is to evaluate long-term effects of a pamidronate-vitamin D-calcium regimen on bone loss, fractures, and safety in recipients of kidney and heart transplants.
Pamidronate improves bone mass in numerous disorders of bone. Other bisphosphonates, as well
as pamidronate, have been proven to be beneficial in steroid-related bone disorders. Steroid
treatment is a major cause of bone loss after organ transplantation. Small, short-term
studies suggest that pamidronate prevents bone loss in kidney and heart transplant
recipients.
Many bisphosphonates cannot be used in patients with decreased kidney function. However,
pamidronate can be given to these patients. This is an advantage of pamidronate in kidney and
heart transplantation because of the frequent occurrence of decreased kidney function in
these groups. Another advantage of pamidronate is that it is administered intravenously. Oral
bisphosphonates commonly produce esophagitis, which is a challenging problem in the
transplant population. Potential side-effects of pamidronate include transient hypocalcemia,
lymphopenia, low-grade fever, myalgias and nausea. Recently, rare cases of proteinuria and
kidney failure were reported in cancer patients receiving high-dose pamidronate. Although
this side effect has not been reported in other types of patients receiving pamidronate, this
is a safety concern that warrants further scrutiny in the transplant population.
In addition to bisphosphonate treatment, supplementation with calcium and vitamin D may
preserve bone after organ transplantation. Prior studies have compared bisphosphonates to
calcium and vitamin D regimens. However, a combination regimen including each of these
treatments may preserve bone mass better than a single treatment. Data regarding treatment
with a combination of a bisphosphonate, calcium, and vitamin D are lacking in kidney and
heart transplantation.
Comparison(s): In a prospective, open-label, single arm trial, Pamidronate (60-90 mg) is
administered within 2 weeks after kidney or heart transplant and every 6 months for 2 years.
Participants are prescribed vitamin D 800 units/d or calcitriol 0.25 microgram/d if serum
creatinine is greater than 2 mg/dl, and calcium carbonate 1500 mg/d.
The primary outcome is bone mineral density measured by dual-energy X-ray absorptiometry at
baseline and after years 1 and 2. Fracture events and serum calcium, parathyroid hormone,
creatinine, and dipstick proteinuria are also measured.
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