Table 1.
Data reported at baseline and at follow-up, n = 76.
Figure 1.
Cumulative dose of immunosuppressive agents and bone mineral density change between three bone conditions by WHO.
The patients were divided, according to their baseline DXA, into normal (n = 5), osteopenia (n = 30), and osteoporosis (n = 41) groups. The osteoporosis group received a significantly greater cumulative prednisolone dose than did the osteopenia group (1326.5 mg vs. 724.5 mg; p = 0.005; Figure 1A), and the increase in lumbar spine bone mineral density was also significantly greater in the osteoporosis group (0.033 g/cm2 vs. 0.009 g/cm2; p = 0.028; Figure 1B). The drugs included in the analysis of cummulative immunosuppresive therapy were prednisolone, 5 mg; mycophenolate, 250 mg; tacrolimus, 0.5 mg; sirolimus, 1 mg; and cyclosporine, 100 mg. Abbreviations: L, lumbar spine; H, hipbone; F, femoral neck. *Statistical significance at p<0.05.
Table 2.
Comparison of patients with (41) and without (35) osteoporosis at presentation and follow-up.
Figure 2.
Clinical variables associated with bone condition change.
A binary (non-osteoporosis and osteoporosis in follow-up) logistic regression analysis was performed to identify the variables associated with osteoporosis. The dependent variable was non-osteoporosis or osteoporosis. The independent variables were age, sex, DM, smoking, alcohol consumption, age at transplantation, time since transplant, use of immunosuppressive agents and use of Fosamax. Both the use of prednisolone (odds ratio [OR], 5.18; 95% confidence interval [CI], 1.6–16.4; p = 0.005) and the use of Fosamax (OR, 18.75; 95% CI, 5.42–64.76; p<0.001) were associated with the symptoms of osteoporosis (Figure 2A). In an ordinal logistic regression with multivariate analysis of the change of bone condition (grade 1, changed to the better; grade 2, no change; and grade 3, deterioration, as defined by WHO criteria and clinical variables), after adjusting for age, sex, status of diabetes (DM), smoking, alcohol consumption, time since transplant, age at transplant, and use of prednisolone, the use of Fosamax (OR, −3.115; 95% CI, −5.364 to −0.866; p = 0.007) was found to be associated with a positive prognosis (Figure 2B).
Table 3.
Comparison of the use and non-use of Fosamax in men and women.