Abstract: TH-PO923

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

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Marques, Igor, Hospital Universitario da UFPI , Teresina, PI, Brazil
  • David-Neto, Elias, University of São Paulo School of Medicine, São Paulo, Brazil
  • Araujo, Maria Julia C. L. N., None, Sao Paulo, São PAULO, Brazil
  • Graciolli, Fabiana, University of Sao Paulo, Sao Paulo, SÃO PAULO, Brazil
  • dos Reis, Luciene, University of Sao Paulo - Medical School - Nephrology Division, Sao Paulo, Brazil
  • Pereira, Rosa M., Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  • Custodio, Melani, Universidade de São Paulo, São Paulo, Brazil
  • Jorgetti, Vanda, Universidade de Sao Paulo, Sao Paulo, SÃO PAULO, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, SÃO PAULO, Brazil
  • Moyses, Rosa M.A., Universidade Nove de Julho, São Paulo, Brazil
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.