Background/Purpose: Data on prevention of fractures after heart transplant (HTx) are controversial in the literature. Understanding the effects of HTx on bone may guide appropriate treatment in this high-risk population.

Methods: Seventy adult patients submitted to HTx were followed for 12 months. Clinical and laboratory parameters, bone mineral density (BMD), body composition, microarchitecture and vertebral fractures were assessed at baseline (intensive care unit discharge), 6 and 12 months. Patients received recommendations regarding calcium intake (1,000mg/day) and vitamin D supplementation (50,000U/week for 3 months, followed by 7,000U/week) after HTx.

Results: At baseline, 27.1% of patients had osteoporosis (T-score ≤-2.5), associated with the length of hospitalization before HTx (p=0.001). BMD decreased in the first 6 months, with partial recovery later. Bone microarchitecture deteriorated, mainly trabecular bone in the first 6 months and cortical bone in the subsequent 6 months. At baseline, 92.9% of patients had vitamin D level < 30ng/mL and 20.0% < 10ng/mL. Patients also had calcium at the lower limit of normal, high alkaline phosphatase, associated with low levels of vitamin D (15.5±9.1 ng/ml). These abnormalities were suggestive of impaired bone mineralization and normalized at 6 months with correction of calcium and vitamin D deficiency. The majority of vertebral fractures were identified at baseline (23.5% of patients). After multivariate analyses, only lower fat mass persisted as a risk factor for vertebral fractures (OR 1.23, 95% CI 1.04-1.47, p=0.012).

Conclusion: Present study showed a high frequency of densitometric osteoporosis, vitamin D deficiency, bone markers abnormalities sugestives of bone mineral defect and vertebral fractures shortly after HTx. Calcium and vitamin D supplementation should be the first step in correcting bone mineralization impairment, before specific osteoporosis treatment. Special attention should be given to patients with long length of hospitalization and low fat mass.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bone-metabolism-impairment-in-heart-transplant-results-from-a-prospective-cohort-study/