The influence of corticosteroids on quantitative ultrasound parameters of the calcaneus in the 1st year after renal transplantation
- 100 Downloads
Steroid-related bone loss is a recognized complication after renal transplantation. Quantitative ultrasound (QUS) of bone measures bone structure besides bone mass. We investigated the influence of corticosteroid therapy on QUS parameters in the 1st year after renal transplantation. A total of 119 renal transplant recipients were randomized to receive either a steroid-free regimen or a regimen with prednisone during 4 months. In 96 patients (steroid-free n=49, steroids n=47), dual-energy X-ray absorptiometry (DXA) parameters of the lumbar spine and the right hip, and QUS parameters of the right calcaneus were measured at baseline, 3, and 12 months after transplantation. Despite a significant difference in steroid use between the two groups, there was no statistically significant difference between the two groups in DXA and QUS parameters at any time point. BMD of the lumbar spine decreased at 3 months and recovered hereafter to the baseline value. BMD of the femoral trochanter decreased at 3 months and remained stable hereafter. The QUS parameter broadband ultrasound attenuation (BUA) was significantly lower at 12 months after transplantation compared with baseline (steroid-free −4.1±1.5%, steroids −2.6±1.5%). In contrast to the DXA parameters, BUA continued to decrease (P<0.05) between 3 and 12 months after transplantation in both groups. It is concluded, that the usage of a moderate dose of steroids during 4 months after renal transplantation had no important influence on QUS parameters of the calcaneus. While BMD remained stable or improved between 3 and 12 months after transplantation, the decrease in BUA seems to reflect a continuing change in bone structure in this population with preexistent renal osteodystrophy.
KeywordsBone mineral density Heel bone Kidney transplantation Quantitative ultrasound Steroid-free
bone mineral density
broadband ultrasound attenuation
dual-energy X-ray absorptiometry
speed of sound
The authors thank M. Engels, technician at the department of nuclear medicine, for expert assistance in performing the bone mineral density measurements, and Mrs M. van Helden, research nurse, for invaluable help in collecting the data. The study design, data analysis, and the writing of the first draft were performed by C. ter Meulen and A. Hoitsma. All authors contributed to the writing of the final manuscript.
- 14.Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:629–634CrossRefPubMedGoogle Scholar
- 16.ter Meulen CG, Riemsdijk-van Overbeeke IC, Hene RJ, Christiaans MHL, Borm G, Corstens FH, van Gelder T, Hilbrands LB, Weimar W, Hoitsma AJ (2004) No important influence of limited steroid exposure on bone mass during the first year after renal transplantation: a prospective, randomized, multicenter study. Transplantation (in press)Google Scholar
- 17.ter Meulen CG, Riemsdijk-van Overbeeke IC, Hene RJ, Christiaans MHL, Borm G, van Gelder T, Hilbrands LB, Weimar W, Hoitsma AJ (2004) Steroid-withdrawal at three days after transplantation with anti-IL-2 receptor alpha therapy: a prospective randomized multicenter study. Am J Transplantation 4:803–810CrossRefGoogle Scholar