74. Bone density in heart transplanted patients in Kingdom of Saudi Arabia

Abstract

Osteopenia and osteoporosis are prevalent in heart transplant candidates. Early, rapid bone loss is a well documented complication of steroid administration after heart transplantation. Purpose of our study was to determine incidence of osteopenia and osteoporosis in heart transplant candidates and heart transplanted patients and association with demographics characteristics, vitamin D deficiency, renal and thyroid function and long-term use of corticosteroids and immunosuppressive drugs. Methods: This is a non-randomized, retrospective, observational study. Medical files of all consecutive heart transplanted patients since the beginning of 2009 until August 2013 were reviewed. Results: Pre-transplant bone mineral density data (BMD) were available in 63 heart transplant recipients; 54 and 32, respectively, also had 1- and 2-years post-transplant BMD data. Pre-transplant lumbar spine (LS) osteopenia or osteoporosis was 35% and 8% compared with 30% and 3% in femoral neck (FN). We found significant decrease in pre-transplant BMD compared with BMD data 1 year after heart transplantation in LS (1.034 ± 0.17 vs.0.994 ± 0.13; p < 0.001) and FN (0.951 ± 0.15 vs. 0.879 ± 0.139; p < 0.001), respectively. There were no significant changes in BMD after 2 years compared with data with 1 year BMD in LS (p = 0.98) and FN (p = 0.11), respectively. BMD in LS and FN were significantly lower in female (0.92 ± 0.157 vs. 1.06 ± 0.163, p = 0.009 and 0.869 ± 0.11 vs. 0.985 ± 0.147, p = 0.017) despite younger age (26 ± 10 vs. 39 ± 13 year, p < 0.001). Vitamin D deficiency is highly representative in the Saudi population (69% of recipients have severe deficiency, level < 25 nmol/L). One year after transplantation 94% of patients are on Vitamin D3 supplement and 91% on Calcium supplement. Despite reduction of severe VITD deficiency to only 8.6% we have significant progress of osteopenia and osteoporosis 1 year after HTx. We have registered 100% use of corticosteroids 1 year after HTx. Conclusion: Anti-resorptive agents, calcium and vitamin D can reduce post transplant bone loss but to eliminate major contributing factor for development of osteoporosis, our patients should undergo steroid weaning 6–9 months after transplantation.