Background: Bone disease is a well-known complication of renal transplantation, and vitamin D and calcium supplementation is commonly used to prevent loss of bone mass. Methods: We investigated whether substitution with calcitriol and calcium would preserve bone mass better than no such supplement during the first year after transplantation. Our intervention group consisted of 63 de novo kidney transplant recipients with early stable renal function (≤ 28 days post-transplantation, GFR ≥ 30 ml/min), who all received oral calcitriol 0.25mcg/day and calcium 500 mg b.i.d for 52 weeks. The control group consisted of 61 patients meeting the same selection criteria, but did not receive calcium or calcitriol supplementation. Baseline differences were analyzed by chi-square and t-tests. Change in BMD Z-score from baseline to 10 and 52 weeks were analyzed using mixed models with random subject intercept adjusting for age, sex and baseline Z-score. Results: Patients in the control group had a tendency towards lower baseline lumbar spine (L2-L4) BMD Z-scores (±SD); -0.7 (1.44) vs -0.23 (1.52), p=0.08, with similar trends in other skeletal compartments. The difference in change in L2-L4 BMD Z-score from baseline to 52 weeks between the intervention group and controls was 0.01, 95%CI (-0.20, 0.21), p=0.95. Subgroup analyses, discriminating on baseline T- or Z-scores (with median, -1.0 SD and -2.5 SD as cut-off limits) showed no difference in treatment effect. Conclusions: Calcium/calcitriol supplementation for 52 weeks did not preserve BMD significantly better than no intervention, but all patients preserved BMD throughout one year.

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