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Submitted on November 4, 2004
Accepted on March 23, 2005
From Division of Endocrinology, and Hematology, Department of Medicine, Department of Obstetrics and Gynecologyand Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
* To whom correspondence should be addressed. E-mail: matti.valimaki{at}hus.fi.
Bisphosphonates have been used to prevent bone loss after solid organ transplantations but not in conjunction of stem cell transplantation (SCT). We tested the hypothesis that additional intravenous pamidronate would prevent bone loss associated with SCT more effectively than the combination of calcium, vitamin D, and sex hormone replacement alone. Ninety-nine adult recipients of allogeneic SCT were randomized by age and gender into two groups. In one group the patients received calcium carbonate 1000 mg and vitamin D 800 IU daily, and females estrogen and males testosterone replacement therapy. In another group the patients received the same treatments plus 6 intravenous infusions of 60 mg of pamidronate before and 1,2,3,6,9 months after SCT. Bone mineral density (BMD) of the lumbar spine and the upper femur, measured by dual-energy x-ray absorptiometry (DXA), and bone turnover markers were followed for 12 months. In the pamidronate group lumbar spine BMD remained stable, but decreased in the other group by 2.9% at 12 months (P = 0.0084 between the groups over time). Total hip BMD reduced 5.1% in the pamidronate group and 7.8% in the other group by 12 months (P = 0.0015), and femoral neck BMD 4.2% and 6.2%, respectively (P = 0.074). In the pamidronate group serum type I procollagen aminoterminal propeptide (PINP) (P = 0.032 between the groups over time) and urinary type I collagen aminoterminal telopeptide (NTX) (P = 0.035) decreased 79% and 68% during the first three months, and remained lowered thereafter, but did not change in the other group. The recipients of allogeneic stem cell transplant receiving additional pamidronate sustain less bone loss than those treated with calcium, vitamin D, and sex hormone replacement alone. Despite all the efforts bone loss is, however, not totally abolished at the hip.
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