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Treatment with Vitamin D and Calcium Reduces Bone Loss after Renal Transplantation: A Randomized Study

Ruud G. L. de Sévaux^*, Andries J. Hoitsma^*, Frans H. M. Corstens and Jack F. M. Wetzels^*

Departments of *Nephrology and Nuclear Medicine, University Medical Center Nijmegen, Nijmegen,The Netherlands.

Correspondence to Dr. R. G. L. de Sévaux, Department of Nephrology, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: 31-24-3614761; Fax: 31-24-3540022; E-mail: r.desevaux{at}nefro.azn.nl

ABSTRACT. 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 µg/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 in lumbar BMD was observed during the first 3 mo (CaD, -3.3 ± 4.3%; P < 0.0001; NoT, -4.1 ± 4.8%; P < 0.0001). Between the third day and sixth month, lumbar BMD 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 mo 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.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673