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DGDispatch 
Calcium Supplementation Prevents Bone Loss in Renal Transplant Patients: Presented at Transplant 2001By W. A. Thomasson Special to DG News
CHICAGO, IL -- May 13, 2001 -- Patients on modern low-corticosteroid immunosuppressive regimens who receive regular calcium supplements experience little if any bone loss, according to a study presented today at the Transplant 2001 meeting. The study, however, found no gain in benefit with vitamin D3 supplementation. It was reported a decade ago that renal transplant patients lose 5 to 10 percent of their bone mass within the first year, but this is no longer true, according to Martin Wissing, MD, and his colleagues at Hôpital ULB-Erasmus in Brussels, Belgium. The study included all the institution's renal transplant patients over a 20-month period except those who received multiple organ transplants, those receiving bisphosphonate therapy, and those with disordered calcium levels. In all 87 patients were randomized to receive either high-dose calcium (400 mg/day) or calcium plus 25,000 units of cholecalciferol (vitamin D3). Dr. Wissing said that there was no placebo group because, "It is considered, now a-days, [that] in patients receiving glucocorticoids, calcium supplementation is the minimal required therapy." Administration of vitamin D3 increased levels of 25-hydroxycholecalciferol, with a highly significant difference from the calcium-only group (in which levels decreased from baseline). There was, however, no difference in calcium levels between the two groups. Both treatment groups experienced frequent hypercalcemia, with treatment being discontinued in six calcium-only and four calcium-cholecalciferol patients due to recurrent episodes. At one year, neither group had a significant change from baseline in bone mineral density as measured at either the lumbar spine or the femoral neck. The mean decrease for both groups combined was 2 percent in the lumbar spine and 1 percent at the femoral neck, but there was wide interpatient variability. Although the study addressed only the effects after the first year of treatment, it seems likely that renal transplant patients should continue calcium supplementation indefinitely. There is no specific need for vitamin D3 supplementation, however.
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