PHILADELPHIA — Weaning heart transplant patients aggressively from steroids and prophylactic treatment with alendronate led to a reduced incidence of osteoporosis in a series of 28 patients, compared with a historic control group.
The alendronate regimen was well tolerated by all 28 patients, Gerald Yong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.
And survival rates among the patients managed with steroid weaning and alendronate were similar to the historic control group that had been treated with full-dose steroids, suggesting that the regimen designed to prevent bone loss did not compromise immunosuppression, said Dr. Yong, a physician in the cardiac transplant unit at Royal Perth Hospital in Australia.
He and his associates reviewed bone mineral density scores, obtained with dual-energy x-ray absorptiometry (DXA) of the femoral neck and lumbar spine, for 28 heart-transplant patients who were treated at Royal Perth since June 1999, when the bone-preserving regimen was instituted, and compared them with a similar group of 28 patients treated at the same center from 1995 to 1999.
Among the 28 patients in the historic control group, 26 were on prednisolone at the time they underwent bone mineral density studies.
Two patients in this group received treatment with either estrogen or vitamin D to prevent osteoporosis.
The patients in the bone-preserving group were all treated with either 10 mg alendronate daily or 70 mg weekly. Steroid weaning was begun at least 6 months after transplantation, and by the time of their DXA scans 16 of the 28 patients were completely off of prednisolone.
The average z scores and T scores at the femoral neck were 0.4 and −0.7 among the patients in the bone-preserving group, compared with −0.6 and −1.2 in the historic controls. The average scores in the lumbar spine were 0 and −0.6 among patients in the bone-preserving group, and −0.9 and −1.3 in the controls.
On the basis of their average z scores and T scores in the femoral neck, osteoporosis was diagnosed in five of the patients on the bone-preserving regimen (18%), compared with eight patients in the control group (29%).