Long-term use of alendronate, a bisphosphonate, may slow bone loss in kidney transplant recipients (KTRs), a new study finds.

Decrease in bone mass commonly occurs in the first 6 to 12 months after kidney transplantation. Transplantation-related risk factors include a longer dialysis vintage, high or low parathyroid hormone (PTH) levels prior to transplantation, persistent hyperparathyroidism after transplantation, pre-existing bone disease, receipt of a deceased donor kidney, immunosuppression such as use of corticoidsteroids, graft dysfunction, hypophosphatemia, hypomagnesemia, hypogonadism, and 25(OH) vitamin D deficiency.

The study included 82 KTRs divided into 3 groups. Group 1 received alendronate along with calcium and vitamin D3; group 2 received calcium and vitamin D3 only; and group 3 received none of these therapies. At baseline, PTH levels were elevated and 25(OH) vitamin D levels were low in all groups.

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Bone mineral density (BMD) was stable at 12 months, then increased in group 1 taking alendronate, whereas it decreased in groups 2 and 3, Zuhal Atan Uçar, MD, of TC Demiroglu Bilim University, Istanbul, Turkey, and colleagues reported in Transplantation Proceedings. In group 1, lumbar spine T score significantly improved from –2.12 to –1.91 and femoral neck T score from –2.0 to –1.74 by 24 months. At baseline, 12 months, and 24 months, BMD at the lumbar spine and femoral neck was significantly lower in group 1 than in the other groups.

“Bone mineral density loss, which increases the mortality rate in kidney transplant recipients in the long term, may develop despite calcium and vitamin D replacement,” according to Dr Uçar’s team. “With the addition of alendronate to treatment, bone loss can be stopped. Long-term continuation of treatment with alendronate may reverse the loss of BMD.”


Uçar ZA, Sinangila A, Ko¸Y, et al. The effect of alendronate on bone mineral disorder in renal transplant patients. Transplant Proc. Published online March 22, 2022. doi:10.1016/j.transproceed.2022.01.016