Effects of three immunosuppressive regimens on vertebral bone density in renal transplant recipients: a prospective study.

The influence of three different immunosuppressive regimens with cyclosporine (CsA) on the development of osteopenia in renal transplant patients was assessed. Fifty-three adults with first kidney transplants participated in a randomized trial to analyze the efficacy of three different immunosuppressive regimens: CsA alone (group 1), CsA plus steroids (group 2), and CsA plus steroids plus azathioprine (group 3). Lumbar spine bone mineral density was assessed by dual energy x-ray absorptiometry every 6 months for 18 months. The values for trabecular mass were expressed as bone mineral density and as a fraction of the standard deviation of the mean of the normal value for patient's sex and decade of age (Z-score). Statistical analysis was performed on Z-score and "Z-score change" (value after 6 months minus the basal value at transplantation). At the 18th month, the Z-score increased significantly in treatment group 1 without steroids (P=0.006) and decreased significantly in steroid-treated groups 2 (P<0.001) and 3 (P<0.001). Comparing the two genders, Z-score decreased less in premenopausal women than in men (P=0.018). "Z-score change" did not correlate with steroid dosage, was high in patients with high basal bone mineral density, and was directly associated with the duration of dialysis (P=0.008). In conclusion, premenopausal transplant recipients showed a lower decrease of lumbar bone mineral density than men. In transplant recipients given CsA with steroids, lumbar bone mineral density decreased significantly, while it increased significantly in patients given CsA alone.

[Substitution estrogen therapy in the prevention of postmenopausal osteoporosis and cardiovascular diseases. Results of long-term therapy]. / La estrogeno-terapia sostitutiva nella prevenzione dell'osteoporosi e della patologia cardiovascolare in postmenopausa. Risultati del trattamento a lungo termine.

In the present report, the current approach to the prevention of metabolic damage deriving from oestrogen deficiency involves the use of protocols that vary in the type of hormone employed and the mode of its administration. A homogenous group of 28 postmenopausal women was treated with natural conjugates oestrogen (0.625 mg per diem per os) on a continuous basis plus MAP (10 mg per diem per os) for 12 days a month. The metabolic effect of the oestrogen replacement therapy was assessed annually by blood chemical screening of the lipid situation and the phosphocalcium balance. Computerised radial bone mineralometry using SPA technique was also performed. A smaller group of 19 court of the 28 patients was also subjected to transversal assessment of vertebral BMD using the DXA technique. The results in this latter group were compared with those in 19 women not given oestrogen treatment who had been postmenopausal from 5-7 years. Results after 60 months of treatment confirm the efficacy of oestrogen therapy in preventing the deterioration of the lipid profile and the loss of bone mass after menopause.