Bone mineral disease in children after renal transplantation in steroid-free and steroid-treated patients - a prospective study

Grenda R, Karczmarewicz E, Rubik J, Matusik H, Płudowski P, Kiliszek M, Piskorski J. Bone mineral disease in children after renal transplantation in steroid‐free and steroid‐treated patients – a prospective study. Pediatr Transplantation 2011: 15:205–213. © 2010 John Wiley & Sons A/S. : Bone disease may persist after transplantation. Different approaches aiming to ameliorate this problem have been investigated. The aim of the study was to compare the long‐term effect of three medical interventions: (i) two prophylactic oral doses of 50 mg ibandronate; (ii) daily oral dose of 0.25 μg of 1α‐OHD3 (both of these regimens in patients receiving steroids), and (iii) steroid minimization immunosuppressive protocol in patients with no other specific prophylaxis. Patients: A total of 37 children, at a mean age of 13.33 ± 3.49 yr, dialyzed for 15.93 ± 16.7 months before transplantation, were divided into three groups, depending on medical intervention. Bone mineral content and density (BMC, BMD, DXA), serum markers of bone resorption and formation (CTX, P1NP), calcium, phosphate, 25OHD3/1.25 (OH)2D3 and PTH concentration were evaluated during two yr of follow‐up. The mean values of BMD in the whole population and among the three subgroups remained within the age‐ and gender‐matched normal range during follow‐up. Patients from groups II (alphacalcidiol) and III (steroid minimization) showed a significant decrease in BMD Z‐scores over time, and this effect was determined with increasing age using multivariate analysis. Patients receiving two doses of ibandronate maintained unchanged Z‐scores for BMD and BMC over time.