• Percent change in PA spine bone density from baseline to 24 months post transplant [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  

• Percent change in PA spine bone density from baseline to 12 months and percent change in total hip bone density from baselint to 24 months [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Patient compliance will be quantified in the alendronate and placebo groups asthe percewntage of pills distributed that were taken. The occurence of side effects will be summarized using descriptive statistics and compared among the treatment groups. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  

The aim are to determin baseline bone mineral density (BMD) in kidney and kidney/pancreas transplant patients who will be randomized to weekly alendronate, annual zoledronic acid infusions or placebo (calcium with Vitamin D). These patients will be follow for two years with annual bone density testing as well as biochemical markers. A secondary aim is to evaluate compliance and tolerability oftaking annual intravenous zoledronic acid versus weekly alendronate in the transplant recipient.

Inclusion Criteria:

• Transplant patients who have had a kidney or kidney/pancreas transplant in the last 150 days with adequate kidney function as defiened by a calculated creatine cleanace of 35ml/min or more and serum creatinine less than 3.0

Exclusion Criteria:

• DXA T-score at the spine or hip of -3 or lower
• History of more than one vertebral or nonvertebral fracture in the past two years
• Abnormalities of the esophagus whic delay esphageal emptying
• Inability to stay upright for 30 minutes
• Pregnant, nursing women or women not using an efective form of birth control
• Hypocalcemia
• Hypercalcemia
• Calculated creatinine clearnace of <35 ml/min or serum creatinine > 3.0
• Patients already treated with bisphosphonates witnin the past one year
• Patients unable to undergo DXA
• Patients with cancer