NEW YORK (Reuters Health) – The high risk of fractures in the first year after solid organ transplantation can be roughly halved with bisphosphonate or vitamin D treatment, according to the results of a meta-analysis reported in the Journal of Clinical Endocrinology and Metabolism published online August 17.

“With treatment, the total number of subjects with fractures, the absolute number of fractures, and number of vertebral fractures were all significantly reduced,” the authors conclude.

Dr. Elizabeth Shane and colleagues at Columbia University College of Physicians and Surgeons in New York, New York note that fracture rates as high as 37% have been reported in the first year after transplantation, and are associated with mortality, significant morbidity, and reduced quality of life.

Numerous randomized clinical trials, they point out, have shown that treatment with bisphosphonates or active metabolites of vitamin D after transplant prevents bone loss during the first year, but differences in fracture rates among treated and untreated patients have not been clear.

The researchers therefore conducted a meta-analysis of 11 studies with a total of 780 participants who experienced a total of 134 fractures in the first year after transplantation. Nine of the trials compared a bisphosphonate with a placebo or no treatment, and two trials compared 1-alpha-hydroxyvitamin D or calcitriol with no treatment.

Treatment reduced the number of patients with fractures (odds ratio 0.50) as well as the number of vertebral fractures (OR 0.24), the results indicated. Analysis of just the bisphosphonate trials showed that the number of fractures was reduced to a similar degree (OR 0.53), but the reduction in vertebral fractures was not significant.

Dr. Shane and colleagues point out that “none of the studies used tacrolimus, which might be associated with less bone loss than cyclosporine and thus could also be associated with lower fracture risk.”

That said, they conclude, “In patients managed with glucocorticoids and cyclosporine A, treatment with bisphosphonates or active vitamin D analogs prevents fractures during the first year after organ transplantation.”

Reference:
Prevention of Fractures after Solid Organ Transplantation: A Meta-Analysis
J Clin Endocrinol Metab 2011;96.