The therapy of osteoporosis in patients with end organ failure and after the transplantation (Tx) becomes more frequent problem with the better patients and graft survival rates. Moreover some of these patients have impaired renal function and therefore cannot use bisphosphonates. The supplementation therapy with calcium and/or vitamin D is frequently not sufficient to improve bone mass. The possible innovative therapy is Denosumab (Prolia inj.) - MAB to RANK, which is not contraindicated in patients with elevated creatinine level.
We have treated osteoporosis in 21 patients (14 females, seven males, age 3968 years) after solid organ Tx performed in years 19962013 with impaired renal function-the mean creatinine level 171.9 μmol/l (110306 μmol/l). Kidney Tx was performed in 11 patients, liver Tx in eight patients, and two patients underwent heart Tx. The osteoporosis was diagnosed with standard DEXA examination on GE instrument Lunar Prodigy. We have used Denosumab 60 mg inj. s.c. every 2 months in years 20112013. All these patients were also treated with calcium and D vitamin and the plasma Ca level was within normal limits during the treatment (mean 2.44 mmol/l). The mean osteocalcin level was 22.6 μg/l (6.554.1 μg/l) parathormone (PTH) 7.12 pmol/l (2.4815.8), (betacross laps 0.389 μg/l (0.0401.020), 25OHD3 33.4 μg/l (14.567.6 μg/l), 1.25(OH)2D3 ng/l (16.495.1 ng/l). All patients were treated with Denosumab minimally for 1 year and 13 patients had repeated DEXA examination after therapy. The BMD of lumbar spine has increased in ten patients, in two patients did not change and slightly decreased in one patient. The BMD of total hip has improved in eight patients, unchanged in four patients and decreased in one patient. The BMD of distal radius has improved in six patients, unchanged in five patients and decreased in two patients.
Summary: The Denosumab therapy increased bone density in most patients after Tx. We did not observe any complications after this therapy. The administration of Denosumab seems to be useful in osteoporotic patients after organ transplantation in which bisphosphonate therapy is contraindicated because of impaired renal function.
17 May 2014 - 20 May 2014