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Abstract Number: 2221

Bone Metabolism Impairment in Heart Transplant: Results from a Prospective Cohort Study

Luis Seguro 1, Rosa Pereira 2, Luciana Seguro3, Valeria Caparbo 3, Monica Avila 1, Sandrigo Mangini 1, Iascara Campos 1, Fabio Gaiotto 1, Fabiana Marcondes-Braga 1 and Fernando Bacal 1, 1Instituto do Coracao (InCor), HCFMUSP, Sao Paulo, 2Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Sao Paulo, Brazil, 3Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: 25-hydroxyvitamin D, fractures and DXA, osteoporosis, transplantation

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Session Information

Date: Tuesday, November 12, 2019

Session Title: Osteoporosis & Metabolic Bone Disease – Basic & Clinical Science Poster

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

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.


Disclosure: L. Seguro, None; R. Pereira, None; L. Seguro, None; V. Caparbo, None; M. Avila, None; S. Mangini, None; I. Campos, None; F. Gaiotto, None; F. Marcondes-Braga, None; F. Bacal, None.

To cite this abstract in AMA style:

Seguro L, Pereira R, Seguro L, Caparbo V, Avila M, Mangini S, Campos I, Gaiotto F, Marcondes-Braga F, Bacal F. Bone Metabolism Impairment in Heart Transplant: Results from a Prospective Cohort Study [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/bone-metabolism-impairment-in-heart-transplant-results-from-a-prospective-cohort-study/. Accessed April 17, 2021.
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