Abstract
Most studies find that precardiac transplantation patients are poorly mineralized; up to 35% of them suffer from vertebral crush fracture after transplantation.
We studied 30 consecutives males cardiac transplant candidates. The mean age was 50.2±1.5 years (mean±SE). Creatinine clearance (82.3±5.1 ml/mn), 25 OH vitamin D (8.9±0.7 ng/ml) and osteocalcin level (22.6±2.4 ng/ml) were in the normal ranges. Mean bone mineral density was low either at lumbar spine (0.905±0.027 gr±cm2) or at femoral neck (0.829±0.021 gr/cm2) (Hologic QDR 1000). Mean Z scores were also low: −1.30±0.24 at lumbar spine, −1.61±0.19 at femoral neck. Parathormone (1-84) level was elevated (53.1±6.8 ng/ml). Parathormone level was highly correlated with lumbar (r=0.512; p=0.004) or femoral (r=0.579; p=0.001) bone mineral density as with lumbar (r=0.524; p=0.003) or femoral (r=0.606; p=0.0004) Z scores.
Two parameters are highly correlated with parathormone level:
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-daily posology of furosemide (r=0.609; p=0.0005)
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-atrial natriuretic factor level (r=0.449; p=0.0128)
Thus, most of the demineralisation of the cardiac transplant candidates is iatrogenic and result from furosemid therapy. Cardiac insufficiency could have a direct role, but the exact mechanism remain unclear.
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Oberlin, F., Rozenberg, S., Guillemant, J. et al. Mineralisation of precardiac transplantation patients: A key role for parathormone. J Bone Miner Metab 12 (Suppl 1), S105–S109 (1994). https://doi.org/10.1007/BF02375685
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DOI: https://doi.org/10.1007/BF02375685