Kidney Week

Abstract: TH-PO923

A Prospective and Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation

Session Information

• Transplantation: AKI, Cardiovascular, and Metabolic Complications
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Marques, Igor, Hospital Universitario da UFPI , Teresina, PI, Brazil

Igor Marques,

• Araujo, Maria Julia C. L. N., None, Sao Paulo, São PAULO, Brazil

Maria Julia C. L. N. Araujo,

• Graciolli, Fabiana, University of Sao Paulo, Sao Paulo, SÃO PAULO, Brazil

Fabiana Graciolli,

• dos Reis, Luciene, University of Sao Paulo - Medical School - Nephrology Division, Sao Paulo, Brazil

Luciene dos Reis,

• Pereira, Rosa M., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil

Rosa M. Pereira,

• Custodio, Melani, Universidade de São Paulo, São Paulo, Brazil

Melani Custodio,

• Jorgetti, Vanda, Universidade de Sao Paulo, Sao Paulo, SÃO PAULO, Brazil

Vanda Jorgetti,

• Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, SÃO PAULO, Brazil

Rosilene M. Elias,

• Moyses, Rosa M.A., Universidade Nove de Julho, São Paulo, Brazil

Rosa M.A. Moyses,

• David-Neto, Elias, University of São Paulo School of Medicine, São Paulo, Brazil

Elias David-Neto,

Background

Bone and mineral disorders occur frequently in kidney transplant (Ktx) recipients and have been associated with a high risk of fracture, morbidity, and mortality. Bisphosphonates may prevent or treat the bone loss promoted by the immunosuppressive regimens used in Ktx.

Methods

We conducted an open-label, prospective, randomized trial to assess the efficacy and safety of zoledronate to prevent the bone loss in the first year after Ktx. Ktx recipients were randomized 1:1 to receive zoledronate (5 mg at baseline) or no treatment (control group). Both groups received vitamin D supplementation. We evaluated bone mineral density (BMD) and microarchitecture with dual-energy X-ray absorptiometry (DXA) and with high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone histomorphometric analyses were done at the time of Ktx and after 12 months of therapy.

Results

Differing from previous studies, after Ktx, neither zoledronate nor control group presented bone loss. Ktx has promoted an increase of BMD in both lumbar spine and total femur (p<0.0001). The late was more pronounced in the zoledronate group (p<0.05). Out of 34 patients, 29 had baseline and follow-up bone biopsies. On histomorphometry, we found that Ktx, but not zoledronate, suppressed bone activity without causing adynamic bone disease. Bone trabecular volume decreased only in zoledronate group (p<0.05). There was an improvement in cortical bone, as depicted by an increase in cortical thickness and a decrease in cortical porosity, in both groups.

Conclusion

In conclusion, we have confirmed that Ktx is not associated with significant bone loss, based on histomorphometric data. Therefore, although zoledronate had a beneficial effect in total femur BMD, the inclusion of bisphosphonates to prevent bone loss should be reconsidered in face of a contemporary immunosuppressive therapy.

Funding

• Government Support - Non-U.S.