A randomized, open-label, controlled trial of monthly oral minodronate or semiannual subcutaneous injection of denosumab for bone loss by androgen deprivation in Asian men with prostate cancer: the PRevention of Osteopenia with Minodronate And DEnosumab (PROMADE) study.

There is still a lack of evidence that minodronate or denosumab prevents bone loss due to androgen deprivation therapy (ADT) in non-Western patients. This study showed that both drugs significantly improved lumbar spine and total hip bone mineral density in Asian men with prostate cancer who received ADT. INTRODUCTION: To evaluate whether monthly oral minodronate or semiannual subcutaneous injection of denosumab improves bone mineral density (BMD) in Asian men with prostate cancer (PCa) receiving ADT. METHODS: A multicenter, open-label, randomized, controlled study including patients with hormone-sensitive PCa without bone metastasis receiving ADT was performed. Patients were randomized (1:1:1) to minodronate, denosumab, or no agent control groups. The primary end point was the mean percentage change in BMD at the lumbar spine at 12 months. Secondary end points were the mean percentage change in BMD at the femoral neck and total hip and changes in bone turnover markers. Statistical comparison was performed using analysis of covariance. RESULTS: Of the 147 subjects enrolled in this study, 102 were randomly assigned into the minodronate (n = 36), denosumab (n = 36), and control (n = 30) groups. The percentage change in BMD at the lumbar spine was significantly improved in the minodronate (2.5%, p < 0.05) and denosumab groups (4.0%, p < 0.01) compared with that in the control group (- 0.1%). Denosumab increased BMD at the femoral neck and total hip at 12 months, whereas minodronate only increased BMD at the total hip compared with controls (all p < 0.05). The percentage change in bone turnover markers at 12 months was significantly lower in the minodronate and denosumab groups compared with that in the control group (both p < 0.01). CONCLUSION: Minodronate or denosumab can be used for preventing bone loss related to ADT in Asian patients with PCa.

Factors Related to Osteosarcopenia in Kidney Transplant Recipients.

INTRODUCTION: Sarcopenia and osteopenia are highly prevalent in older patients, and are associated with a high risk for falls, fractures, and further functional decline. However, related factors in kidney transplant recipients suffering from osteosarcopenia, the combination of sarcopenia and osteopenia, remain unknown. MATERIAL AND METHODS: Fifty-eight transplant recipients (42 men and 16 women), with a mean age of 46.6 ± 12.7 years, were enrolled in this study. Sarcopenia was diagnosed according to the criteria of the Asia Working Group for Sarcopenia. Osteopenia was diagnosed according to World Health Organization criteria using bone mineral density (BMD) of the lumbar spine. Patients who met the diagnostic criteria of both diseases were defined as having osteosarcopenia. RESULTS: Ten patients had osteosarcopenia. According to univariate analyses, there were significant differences between osteosarcopenia group and non osteosarcopenia group in age (P = .002), duration of dialysis (P = .013), vitamin D levels (P = .002), and MET (P = .007). There was a significant positive correlation between vitamin D level and MET (r = .464; P < .001). The results of the multivariate analysis indicated that only MET was a relevant factor in osteosarcopenia. CONCLUSION: Duration of dialysis, low vitamin D levels, and physical activity after kidney transplantation were related to osteosarcopenia. These results suggested that osteosarcopenia in kidney transplant recipients is a carryover from the dialysis period.

Dual Energy X-ray Absorptiometry and Bioimpedance Analysis are Clinically Useful for Measuring Muscle Mass in Kidney Transplant Recipients With Sarcopenia.

PURPOSE: Computed tomography (CT) is considered the gold standard method for the diagnosis and characterization of sarcopenia. The aim of the present study was to determine the correlation between the volume of psoas muscle measured using CT and the measurement of muscle mass with dual energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) in kidney transplant recipients. METHODS: Fifty-eight recipients (42 males and 16 females) were enrolled. Diagnostic criteria for sarcopenia were according to those of the Asia Working Group for Sarcopenia. The volume of psoas muscle was extracted using image recognition software from three-dimensional CT images. RESULTS: The volume of psoas muscle was 227.2 ± 61.3 mL in Group 1 (sarcopenia), 283.9 ± 75.3 mL in Group 2 (presarcopenia), and 363.7 ± 138.0 mL in Group 3 (without sarcopenia). Muscle mass measured using DXA was 15.80 ± 3.19 kg in Group 1, 16.36 ± 2.49 kg in Group 2, and 21.21 ± 4.14 kg in Group 3. Additionally, muscle mass assessed using BIA was 17.22 ± 4.11 kg in Group 1, 17.86 ± 3.30 kg in Group 2, and 21.48 ± 5.39 kg in Group 3. There were significant differences in the mean volume of psoas muscle between the 3 groups. There was a significant positive correlation between the volume of psoas muscle and the muscle mass assessed using DXA (r = 0.797; P < .001) and BIA (r = 0.761; P < .001). Furthermore, there was a significant positive correlation between DXA and BIA (r = 0.900; P < .001). CONCLUSIONS: It was suggested that estimating muscle mass using DXA and BIA is a preferred method for diagnosis of sarcopenia in kidney transplant recipients.

Factors Associated With the Development of Sarcopenia in Kidney Transplant Recipients.

INTRODUCTION: Sarcopenia is characterized by an involuntary loss of skeletal muscle mass, strength, and function. Previous studies suggest that it is generally associated with aging and chronic kidney diseases. The focus of this study was on the association between sarcopenia and pre-sarcopenia in kidney transplant recipients. METHODS: Fifty-one patients who underwent kidney transplantation at Kansai Medical University Hospital were enrolled, and their sarcopenia status was evaluated between April and July 2016. Sarcopenia was defined according to the criteria for the Asia Working Group for Sarcopenia. Skeletal muscle mass index was measured by using dual-energy radiograph absorptiometry; the cutoff points were <7.0 kg/m2 for male subjects and <5.4 kg/m2 for female subjects. For hand grip strength, values <26 kg (male subjects) and <17 kg (female subjects) was judged as sarcopenia. In both sexes, the cutoff point for walking speed was <0.8 m/s. RESULTS: Fifty-one recipients (36 men and 15 women) who met the inclusion criteria were enrolled in the study. The mean age of the recipients was 46.2 ± 12.8 years, and the mean duration of dialysis was 2.72 ± 3.61 years. Overall, 6 recipients (11.8%) had sarcopenia, and 25 recipients (49.0%) had pre-sarcopenia; 20 (39.2%) did not have sarcopenia. There were significant differences in age, duration of dialysis, body mass index, and triglyceride levels between the subgroups of recipients with and without sarcopenia. Multivariate regression analysis showed that age and duration of dialysis were independent variables for sarcopenic status. CONCLUSIONS: Our observations indicate that age and duration of dialysis before transplantation were independent determinants of sarcopenia and pre-sarcopenia in these kidney transplant recipients.

Comparison of Cosmesis and Body Image After Laparoendoscopic Single-Site Versus Conventional Laparoscopic Donor Nephrectomy.

BACKGROUND: This study used a questionnaire to objectively assess the body image of donors who underwent conventional laparoscopic donor nephrectomy (L-DN) or laparoscopic single-site donor nephrectomy (LESS-DN). Surgical outcomes were compared between the two groups. METHODS: Twenty patients underwent L-DN and 20 underwent LESS-DN. The postoperative outcomes of the two approaches were retrospectively compared and evaluated for differences in cosmesis and body image. The questionnaire comprised a body image questionnaire, including a body image scale (BIS) and cosmetic scale (CS), and a photo-series questionnaire (PSQ). A higher score indicated a more favorable assessment. Pain was assessed by comparing the number of times an analgesic was administered during hospitalization. RESULTS: There were no significant differences in operative outcomes between L-DN and LESS-DN. The average BIS score (maximum possible, 20 points) was 18.5 points for patients who underwent L-DN and 19.5 points for patients who underwent LESS-DN (P = .025). Patients who underwent L-DN had a median CS score (maximum possible, 24 points) of 17.5 points, whereas patients who underwent LESS-DN had a median CS score of 19.0 points (P = .113). The average PSQ score was 7.1 points for patients who underwent L-DN and 8.8 points for patients who underwent LESS-DN (P = .01). Patients who underwent LESS-DN were administered an analgesic was significantly number of times less than patients who underwent DN (P = .01). CONCLUSIONS: LESS-DN results in a better body image and better cosmetic appearance than does L-DN, indicating the clinical usefulness of LESS-DN.

Comparison of Renal Scintigraphy and Computed Tomographic Renal Volumetry for Determining Split Renal Function and Estimating Post-Transplant Renal Function.

BACKGROUND: In living donor kidney transplantation, the decision regarding which donor kidney to transplant is based on characteristics such as vascular anatomy and split renal function (SRF). Computed tomography (CT) was used to assess vascular anatomy and renal scintigraphy was used to evaluate SRF. The ability of split renal volume (SRV) calculated from volumetric examination of CT scans and that of SRF of renal scintigrams derived from Tc-99m mercaptoacetyltriglycine-3 (MAG3) renography to predict donor residual single kidney function after donor nephrectomy were compared. MATERIAL AND METHODS: CT images and renal scintigrams from 35 live kidney donors who had at least 1 year post-donation renal function follow-up were analyzed. RESULTS: Predonation GFR was 99.1 ± 17.2 mL/min/1.73 m(2). The average right and left kidney volumes were 138.8 ± 29.4 mL and 136.1 ± 29.2 mL, respectively. SRV was strongly and significantly correlated with SRF-MAG3 (r = 0.714). The residual renal functions predicted from calculating SRV and SRF-MAG3 were 46.2 ± 8.3 mL/min/1.73 m(2) and 46.0 ± 9.2 mL/min/1.73 m(2), respectively. Both SRV (r = 0.708) and SRF-MAG3 (r = 0.634) showed significant linear correlations with residual renal function after 1 year, with SRV showing a stronger correlation. CONCLUSION: Calculating SRV from predonation CT examination is a valid method to estimate postdonation renal function after 1 year. CT volumetry may become a standard method in the near future.