Effects of immunosuppressive regimens with cyclosporine and other risk factors on bone mineral density in cardiac transplant recipients.

• Main Authors: Kuo Hsin Lei, 郭欣蕾
• Other Authors: 陳燕惠
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/24201538095511523824

碩士 === 國立臺灣大學 === 藥學研究所 === 91 === Background. Cardiac transplantation is associated with increased incidence of osteoporosis, and rapid bone loss has been reported during the first 6 to 12 posttransplant months. It is well established that prednisolone may induce osteopenia, but the effect of cyclosporine on bone mineral density is controversial. Therefore, we conducted a cross-sectional evaluation of bone status to find out the predictors of osteopenia in cardiac transplant recipients. Methods. The bone mineral density (dual energy X-ray absorptiometry, DEXA) of spine (L2-L4) and right femoral neck and biochemical index of mineral metabolism were examined in all cardiac transplant patients, presenting for routine evaluation in National Taiwan University Hospital. We collected the data of exposure of cyclosporine and prednisolone, and the dietary intake. Results. Forty-one (33 male vs 8 female, aged 51.3+13.6 vs 45.4+13.3 years) cardiac graft recipients were enrolled in our study. According to the World Health Organization definition, osteoporosis and osteopenia were observed in 7 (17%) and 20 (49%) patients, respectively. Thirty-seven patients were routinely evaluated with minimal follow-up for 2 years after transplantation. Results showed that femoral neck bone mineral density was positively correlated with patients’ cyclosporine current dose (r=0.33, p <0.05) in this group. No significant differences were found between characteristics of BMD normal and non-normal (including osteopenia and osteoporosis) patients, except for age and cyclosporine current dose. The bone formation marker (serum Bone-specific Alkaline Phosphatase, Bone-ALP) and resorption marker (urinary N-terminal telopeptide of type I collagen, NTx) were within normal range. Conclusions. It suggested that cyclosporine, together with the decrease in prednisolone dosage, may protect bone loss in late cardiac transplant recipients. However, these patients had lower bone mineral density than non-transplant population. Therapeutic intervention in osteoporotic or severe osteopenic patients is urgently needed.