Effect of Calcium and Vitamin D on Bone Health among Kidney Transplant Recipients in a Prospective Randomized Controlled Trial

Background: Bone disease in posttransplantation of the kidney characterized by changes in bone quality and density as well as mineral metabolism is a major cause of morbidity in kidney transplant recipients, with a significantly higher risk of fractures as well as increased health-care costs. Several studies have shown that Vitamin D therapy prevents bone loss in nontransplant patients with corticosteroid-induced osteoporosis. However, because of the concern about the risk of hypercalcemia, the use of Vitamin D in this setting has been limited. In this open-labeled, randomized, and controlled prospective intervention trial, we compared the effect of calcium alone versus calcium plus intermittent calcitriol therapy on bone loss after renal transplant (RT). We reasoned that intermittent calcitriol might minimize the risk of hypercalcemia. Materials and Methods: This is an open-label prospective randomized control trial study, conducted in the Department of Nephrology, IPGME and R and SSKM Hospital. A total of 41 patients who were transplanted at the Department of Nephrology and attending outpatient department services constituted the study population from February 2017 to May 2018. Each patient was followed for at least 6 months. Patients were randomly assigned to two groups through GraphPad with 21 patients receiving calcitriol and 20 patients receiving calcium only. Results: Most of the patients were relatively young around 30 years in both groups (29.10 ± 7.06 and 31.95 ± 8.24), and were male. A statistically significant difference was found in serum creatinine in the 3[sup.rd] month between calcium and calcitriol groups. However, no significant difference was found in the 6[sup.th] month between the groups. There were, as expected, statistically significant falls in intact parathyroid hormone (PTH) in the 3[sup.rd] and 6[sup.th] months posttransplant in both calcium and calcitriol groups. Statistically significant improvement of Vitamin D level was seen in both the groups posttransplant in all time periods as expected. The decline was statistically significant in serum phosphorus level at the end of the 6[sup.th] month between the groups (P < 0.01). The incidence of hypercalcemia is more in the calcitriol group. A statistically significant change in bone mineral density (BMD) in the lumbar spine was seen in the 3[sup.rd] and 6[sup.th] months (P < 0.001). However, the change in BMD in radius was not statistically significant between the two groups in the