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Sponsors and Collaborators: |
Providence Health Care The Heart Institute of Spokane Ochsner Health System University of Washington |
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Information provided by: | Providence Health Care |
ClinicalTrials.gov Identifier: | NCT00302627 |
Bone is lost rapidly and fractures occur in 10-20% of patients who receive organ transplants within 2 years. The purpose of this study is to evaluate long-term effects of a pamidronate-vitamin D-calcium regimen on bone loss, fractures, and safety in recipients of kidney and heart transplants.
Condition | Intervention |
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Transplant Bone Disease |
Drug: Pamidronate Drug: vitamin D Drug: calcium supplement |
Study Type: | Interventional |
Study Design: | Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study |
Official Title: | Pamidronate, Vitamin D, and Calcium for the Bone Disease of Kidney and Heart Transplantation |
Estimated Enrollment: | 66 |
Study Start Date: | January 1999 |
Estimated Study Completion Date: | December 2002 |
Pamidronate improves bone mass in numerous disorders of bone. Other bisphosphonates, as well as pamidronate, have been proven to be beneficial in steroid-related bone disorders. Steroid treatment is a major cause of bone loss after organ transplantation. Small, short-term studies suggest that pamidronate prevents bone loss in kidney and heart transplant recipients.
Many bisphosphonates cannot be used in patients with decreased kidney function. However, pamidronate can be given to these patients. This is an advantage of pamidronate in kidney and heart transplantation because of the frequent occurrence of decreased kidney function in these groups. Another advantage of pamidronate is that it is administered intravenously. Oral bisphosphonates commonly produce esophagitis, which is a challenging problem in the transplant population. Potential side-effects of pamidronate include transient hypocalcemia, lymphopenia, low-grade fever, myalgias and nausea. Recently, rare cases of proteinuria and kidney failure were reported in cancer patients receiving high-dose pamidronate. Although this side effect has not been reported in other types of patients receiving pamidronate, this is a safety concern that warrants further scrutiny in the transplant population.
In addition to bisphosphonate treatment, supplementation with calcium and vitamin D may preserve bone after organ transplantation. Prior studies have compared bisphosphonates to calcium and vitamin D regimens. However, a combination regimen including each of these treatments may preserve bone mass better than a single treatment. Data regarding treatment with a combination of a bisphosphonate, calcium, and vitamin D are lacking in kidney and heart transplantation.
Comparison(s): In a prospective, open-label, single arm trial, Pamidronate (60-90 mg) is administered within 2 weeks after kidney or heart transplant and every 6 months for 2 years. Participants are prescribed vitamin D 800 units/d or calcitriol 0.25 microgram/d if serum creatinine is >2 mg/dl, and calcium carbonate 1500 mg/d.
The primary outcome is bone mineral density measured by dual-energy X-ray absorptiometry at baseline and after years 1 and 2. Fracture events and serum calcium, parathyroid hormone, creatinine, and dipstick proteinuria are also measured.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
United States, Washington | |
Providence Medical Research Center | |
Spokane, Washington, United States, 99204 |
Principal Investigator: | Katherine R. Tuttle, MD,FASN,FACP | Providence Medical Research Center |
Study ID Numbers: | HI497 |
Study First Received: | March 10, 2006 |
Last Updated: | August 1, 2007 |
ClinicalTrials.gov Identifier: | NCT00302627 History of Changes |
Health Authority: | United States: Institutional Review Board |
bisphosphonates vitamin D calcium supplement corticosteroid therapy fractures |
Fractures, Bone Bone Density Conservation Agents Trace Elements Bone Diseases Calcium, Dietary Vitamin D Diphosphonates |
Musculoskeletal Diseases Urologic Diseases Vitamins Pamidronate Kidney Diseases Micronutrients |
Vitamin D Urologic Diseases Musculoskeletal Diseases Growth Substances Vitamins Physiological Effects of Drugs |
Pamidronate Bone Density Conservation Agents Micronutrients Kidney Diseases Bone Diseases Pharmacologic Actions |