维生素D、双膦酸盐及联合疗法对肾移植患者骨密度的影响。

Impact of vitamin D, bisphosphonate, and combination therapy on bone mineral density in kidney transplant patients.

作者信息

Jeon H J, Han M, Jeong J C, Kim Y J, Kwon H Y, Koo T Y, Ahn C, Yang J

机构信息

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Transplant Proc. 2013 Oct;45(8):2963-7. doi: 10.1016/j.transproceed.2013.08.066.

DOI:10.1016/j.transproceed.2013.08.066

PMID:24157013

Abstract

BACKGROUND

Osteoporosis can develop and become aggravated in kidney transplant patients; however, the best preventive options for post-transplantation osteoporosis remain controversial.

METHODS

We retrospectively analyzed cohort of 182 renal transplant recipients of mean age 46.7 ± 12.1 years including 47.3% women. Seventy-three patients received neither vitamin D nor bisphosphonate after transplantation (group 1). The other patients were classified into the following 3 groups: calcium plus vitamin D (group 2; n = 40); bisphosphonate (group 3; n = 18); and both regimens (group 4; n = 51). Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry at baseline and at 1 year after transplantation.

RESULTS

At 1 year after transplantation, T-scores of the femoral neck and entire femur were significantly decreased in group 1 (-0.23 ± 0.65 [P = .004] and -0.21 ± 0.74 [P = .018], respectively), whereas the lumbar spine was significantly increased in group 4 (0.27 ± 0.79; P = .020). Post hoc analysis demonstrated that the delta T-score was significantly lower in group 1 than in group 4 (P = .009, 0.035, and 0.031 for lumbar spine, femoral neck, and entire femur, respectively). In a multivariate analysis adjusted by age, sex, body mass index, dialysis duration, diabetes, calcineurin inhibitors, estimated glomerular filtration rate, and persistent hyperparathyroidism, both group 2 and group 4 showed protective effects on BMD reduction (odds ratio [OR], 0.165; 95% confidence interval [CI] 0.032-0.845 [P = .031]; and OR, 0.169; 95% CI, 0.045-0.626 [P = .008]; respectively). However, group 3 did not show a protective effect (OR, 0.777; 95% CI, 0.198-3.054; P = .718), because their incidence of persistent hyperparathyroidism after transplantation was significantly higher (50.0%) than the other groups (P < .001). The incidence of bone fractures did not differ among the groups.

CONCLUSIONS

Combination therapy with vitamin D and bisphosphonate was the most effective regimen to improve BMD among kidney recipients.

摘要

背景

肾移植患者会发生骨质疏松并加重；然而，移植后骨质疏松的最佳预防方案仍存在争议。

方法

我们回顾性分析了182例平均年龄为46.7±12.1岁的肾移植受者队列，其中女性占47.3%。73例患者移植后既未接受维生素D也未接受双膦酸盐治疗（第1组）。其他患者分为以下3组：钙加维生素D组（第2组；n = 40）；双膦酸盐组（第3组；n = 18）；两种治疗方案联合组（第4组；n = 51）。在基线和移植后1年通过双能X线吸收法评估骨密度（BMD）。

结果

移植后1年，第1组股骨颈和全股骨的T值显著降低（分别为-0.23±0.65 [P = .004]和-0.21±0.74 [P = .018]），而第4组腰椎的T值显著升高（0.27±0.79；P = .020）。事后分析表明，第1组的T值变化显著低于第4组（腰椎、股骨颈和全股骨的P值分别为.009、0.035和0.031）。在按年龄、性别、体重指数、透析时间、糖尿病、钙调神经磷酸酶抑制剂、估计肾小球滤过率和持续性甲状旁腺功能亢进进行校正的多变量分析中，第2组和第4组均显示出对骨密度降低的保护作用（优势比[OR]，0.165；95%置信区间[CI] 0.032 - 0.845 [P = .031]；以及OR，0.169；95% CI，0.045 - 0.626 [P = .008]）。然而，第3组未显示出保护作用（OR，0.777；95% CI，0.198 - 3.054；P = .718），因为他们移植后持续性甲状旁腺功能亢进的发生率显著高于其他组（50.0%）（P < .001）。各组间骨折发生率无差异。