Skip to main content

Advertisement

SpringerLink
Log in

The influence of corticosteroids on quantitative ultrasound parameters of the calcaneus in the 1st year after renal transplantation

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

BMD:

bone mineral density

BUA:

broadband ultrasound attenuation

DXA:

dual-energy X-ray absorptiometry

QUS:

quantitative ultrasound

SOS:

speed of sound

References

  1. Ramsey-Goldman R, Dunn JE, Dunlop DD, Stuart FP, Abecassis MM, Kaufman DB, Langman CB, Salinger MH, Sprague SM (1999) Increased risk of fracture in patients receiving solid organ transplants. J Bone Miner Res 14:456–463

    CAS  PubMed  Google Scholar 

  2. Julian BA, Laskow DA, Dubovsky J, Dubovsky EV, Curtis JJ, Quarles LD (1991) Rapid loss of vertebral mineral density after renal transplantation. N Engl J Med 325:544–550

    CAS  PubMed  Google Scholar 

  3. Almond MK, Kwan JT, Evans K, Cunningham J (1994) Loss of regional bone mineral density in the first 12 months following renal transplantation. Nephron 66:52–57

    CAS  PubMed  Google Scholar 

  4. Horber FF, Casez JP, Steiger U, Czerniak A, Montandon A, Jaeger P (1994) Changes in bone mass early after kidney transplantation. J Bone Miner Res 9:1–9

    CAS  PubMed  Google Scholar 

  5. De Sevaux RG, Hoitsma AJ, Corstens FH, Wetzels JF (2002) Treatment with vitamin D and calcium reduces bone loss after renal transplantation: a randomized study. J Am Soc Nephrol 13:1608–1614

    PubMed  Google Scholar 

  6. De Sevaux RG, Hoitsma AJ, van Hoof HJ, Corstens FJ, Wetzels JF (2003) Abnormal vitamin D metabolism and loss of bone mass after renal transplantation. Nephron Clin Pract 93:C21–C28

    Article  PubMed  Google Scholar 

  7. Mikuls TR, Julian BA, Bartolucci A, Saag KG (2003) Bone mineral density changes within six months of renal transplantation. Transplantation 75:49–54

    Article  CAS  PubMed  Google Scholar 

  8. Grotz WH, Mundinger FA, Gugel B, Exner V, Kirste G, Schollmeyer PJ (1994) Bone fracture and osteodensitometry with dual energy X-ray absorptiometry in kidney transplant recipients. Transplantation 58:912–915

    CAS  PubMed  Google Scholar 

  9. Parker CR, Freemont AJ, Blackwell PJ, Grainge MJ, Hosking DJ (1999) Cross-sectional analysis of renal transplantation osteoporosis. J Bone Miner Res 14:1943–1951

    CAS  PubMed  Google Scholar 

  10. Delling G, Amling M (1995) Biomechanical stability of the skeleton--it is not only bone mass, but also bone structure that counts. Nephrol Dial Transplant 10:601–606

    CAS  PubMed  Google Scholar 

  11. Hruska K (1998) New concepts in renal osteodystrophy. Nephrol Dial Transplant 13:2755–2760

    Article  CAS  PubMed  Google Scholar 

  12. Njeh CF, Fuerst T, Diessel E, Genant HK (2001) Is quantitative ultrasound dependent on bone structure? A reflection. Osteoporos Int 12:1–15

    Article  CAS  PubMed  Google Scholar 

  13. Njeh CF, Boivin CM, Langton CM (1997) The role of ultrasound in the assessment of osteoporosis: a review. Osteoporos Int 7:7–22

    Article  CAS  PubMed  Google Scholar 

  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 157:629–634

    Article  CAS  PubMed  Google Scholar 

  15. Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO, Delmas PD, Pouilles JM, Breart G, Meunier PJ (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348:511–514

    Article  CAS  PubMed  Google 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 4:803–810

    Article  Google Scholar 

  18. Fournier B, Chappard C, Roux C, Berger G, Laugier P (1997) Quantitative ultrasound imaging at the calcaneus using an automatic region of interest. Osteoporos Int 7:363–369

    CAS  PubMed  Google Scholar 

  19. Gluer CC (1999) Monitoring skeletal changes by radiological techniques. J Bone Miner Res 14:1952–1962

    CAS  PubMed  Google Scholar 

  20. Blanckaert F, Cortet B, Coquerelle P, Flipo RM, Duquesnoy B, Marchandise X, Delcambre B (1997) Contribution of calcaneal ultrasonic assessment to the evaluation of postmenopausal and glucocorticoid-induced osteoporosis. Rev Rhum Engl Ed 64:305–313

    CAS  PubMed  Google Scholar 

  21. Martin JC, Munro R, Campbell MK, Reid DM (1997) Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol 36:43–49

    Article  CAS  PubMed  Google Scholar 

  22. Daens S, Peretz A, de M, V, Moris M, Bergmann P (1999) Efficiency of quantitative ultrasound measurements as compared with dual-energy X-ray absorptiometry in the assessment of corticosteroid-induced bone impairment. Osteoporos Int 10:278–283

    Article  CAS  PubMed  Google Scholar 

  23. Flohr F, Lutz A, App EM, Matthys H, Reincke M (2002) Bone mineral density and quantitative ultrasound in adults with cystic fibrosis. Eur J Endocrinol 146:531–536

    CAS  PubMed  Google Scholar 

  24. Kos-Kudla B, Pluskiewicz W (1997) Quantitative ultrasound of the heel and serum and urinary cortisol values in assessment of long-term corticotherapy side effects in female bronchial asthma patients. Ultrasound Med Biol 23:1325–1330

    Article  CAS  PubMed  Google Scholar 

  25. Gregg EW, Kriska AM, Salamone LM, Roberts MM, Anderson SJ, Ferrell RE, Kuller LH, Cauley JA (1997) The epidemiology of quantitative ultrasound: a review of the relationships with bone mass, osteoporosis and fracture risk. Osteoporos Int 7:89–99

    CAS  PubMed  Google Scholar 

  26. Jorgensen HL, Warming L, Bjarnason NH, Andersen PB, Hassager C (2001) How does quantitative ultrasound compare to dual X-ray absorptiometry at various skeletal sites in relation to the WHO diagnosis categories? Clin Physiol 21:51–59

    Article  CAS  PubMed  Google Scholar 

  27. Ringe JD, Dorst A, Faber H, Ibach K, Preuss J (2003) Three-monthly ibandronate bolus injection offers favourable tolerability and sustained efficacy advantage over two years in established corticosteroid-induced osteoporosis. Rheumatology 42:743–749

    Article  CAS  PubMed  Google Scholar 

  28. Friedlander AL, Genant HK, Sadowsky S, Byl NN, Gluer CC (1995) A two-year program of aerobics and weight training enhances bone mineral density of young women. J Bone Miner Res 10:574–585

    CAS  PubMed  Google Scholar 

  29. Link TM, Saborowski, Kisters K, Kempkes M, Kosch M, Newitt D, Lu Y, Waldt S, Majumdar S (2002) Changes in calcaneal trabecular bone structure assessed with high-resolution MR imaging in patients with kidney transplantation. Osteoporos Int 13:119–129

    Article  CAS  PubMed  Google Scholar 

  30. Kovac D, Lindic J, Kandus A, Bren FA (2003) Quantitative ultrasound of the calcaneus and dual X-ray absorptiometry of the lumbar spine in assessment and follow-up of skeletal status in patients after kidney transplantation. Osteoporos Int 14:166–170

    CAS  PubMed  Google Scholar 

  31. Kosch M, Hausberg M, Link T, Kemkes M, Barenbrock M, Dietl KH, Matzkies F, Rahn KH, Kisters K (2000) Measurement of skeletal status after renal transplantation by quantitative ultrasound. Clin Nephrol 54:15–21

    CAS  PubMed  Google Scholar 

  32. Mondry A, Hetzel GR, Willers R, Feldkamp J, Grabensee B (2001) Quantitative heel ultrasound in assessment of bone structure in renal transplant recipients. Am J Kidney Dis 37:932–937

    CAS  PubMed  Google Scholar 

  33. Cummings SR, Palermo L, Browner W, Marcus R, Wallace R, Pearson J, Blackwell T, Eckert S, Black D (2000) Monitoring osteoporosis therapy with bone densitometry: misleading changes and regression to the mean. Fracture Intervention Trial Research Group. JAMA 283:1318–1321

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. 545 Department of Nephrology, University Medical Centre Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Cornelis G. ter Meulen, Luuk B. Hilbrands & Andries J. Hoitsma

  2. Department of Internal Medicine, Viecurie Hospital Noord Limburg, Limburg, The Netherlands

    Joop P. W. van den Bergh

  3. Department of Endocrinology, University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Ad R. Hermus

Authors
  1. Cornelis G. ter Meulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luuk B. Hilbrands
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joop P. W. van den Bergh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ad R. Hermus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andries J. Hoitsma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cornelis G. ter Meulen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

ter Meulen, C.G., Hilbrands, L.B., van den Bergh, J.P.W. et al. The influence of corticosteroids on quantitative ultrasound parameters of the calcaneus in the 1st year after renal transplantation. Osteoporos Int 16, 255–262 (2005). https://doi.org/10.1007/s00198-004-1628-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1628-z

Keywords

Search

Navigation