Background: Osteoporosis can develop and become aggravated in a large number of kidney transplant patients; however, the best preventive options for post-transplant osteoporosis remain controversial.

Methods: A total of 182 renal transplant recipients [age, 46.7±12.1 (mean ± SD) years; female, 47.3%] at the Seoul National University Hospital were retrospectively analyzed. Seventy-three patients received neither vitamin D nor bisphosphonate after transplantation (group 1). The other patients were classified into the following 3 groups: calcium plus vitamin D (group 2, n=40), bisphosphonate (group 3, n=18), and both (group 4, n=51). Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry at baseline and 1 year after transplant.

Results: At 1 year after transplantation, T-scores of the femur neck and entire femur significantly decreased in group 1 [-0.23±0.65 (P=0.004) and -0.21±0.74 (P=0.018), respectively], whereas the T-score of the lumbar spine significantly increased in group 4 (0.27±0.79, P=0.020). Post-hoc analysis demonstrates that the delta T-score was significantly lower in group 1 than group 4 (P=0.009, 0.035, 0.031 for lumbar spine, femur neck, and entire femur, respectively). In a multivariate analysis adjusted by age, gender, body mass index, dialysis duration, diabetes, calcineurin inhibitors, eGFR, and persistent hyperparathyroidism, both group 2 and group 4 showed protective effects on BMD reduction (OR 0.165, 95% CI 0.032-0.845, P=0.031 and OR 0.169, CI 0.045-0.626, P=0.008, respectively). However, group 3 did not show a protective effect (OR 0.777, CI 0.198-3.054, P=0.718) because the incidence of persistent hyperparathyroidism after transplant was significantly higher (50.0%) than for the other groups (P< 0.001). The incidence of bone fractures did not differ among the groups.

Conclusion: Combination therapy with vitamin D and bisphosphonate was the most effective at improving the BMD of kidney recipients.

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