Ibandronate and Calcitriol Reduces Fracture Risk, Reverses Bone Loss, and Normalizes Bone Turnover After lTX

Background. Osteoporosis is a common complication in long-term survivors after liver transplantation (LTX). This study investigates the influence of a combination therapy of low dose parenteral ibandronate (IBN) and calcitriol on top of calcium and vitamin D supplementation in such patients. Methods. For 3 years, 30 osteoporotic patients after LTX(28 +/- 6 months) were treated with quarterly 2 mg IBN intravenously and daily calcitriol (0.25-1.0 mu g) on top of 1000 mg calcium and 800 IU vitamin D. Recipients with normal bone density (n=24) were enrolled as controls. Laboratory analysis and dual energy X-ray absorptiometry were performed at baseline and every 12 months. Primary endpoints were changes in bone mineral density and fracture incidence. Results. IBN patients showed a significant increase of bone mineral density at the femoral neck and the trochanteric region (13% and 15%, respectively, both P=0.001) as compared with baseline whereas the control group revealed a small but significant loss of -5.0% in the trochanteric and -4.9% in the neck region (P<0.05) over the same time period. Fracture incidence was low among IBN patients (7%); however, 23% of the control patients sustained at least one vertebral fracture. The relative fracture risk was 3.21 for IBN patients (95% confidence interval, 0.6-20.9, P=0.03) resulting in an absolute risk reduction for a new vertebral fracture of 14%. Conclusion. In LTX recipients with osteoporosis combination therapy with low dose IBN and calcitriol on top of calcium and vitamin D supplementation is an effective treatment option.