Osteoporosis after Kidney Transplantation

Does active Vitamin D prevent bone loss?

Kidney transplant recipients are at increased risk of bone loss due to the effects of medication and metabolic changes. In a study by Khairallah P et al, researchers evaluated whether oral calcitriol (active vitamin D) could help prevent bone loss in patients managed with steroid-free immunosuppression. Sixty-seven patients were randomized to receive either calcitriol or a placebo for 12 months. The results showed no significant differences in bone density, quality, or strength between the two groups. Biochemical markers evolved similarly in both groups as well. However, the incidence of hypercalcemia was higher among those taking calcitriol compared to placebo. The study concluded that calcitriol does not prevent bone loss and may raise the risk of hypercalcemia, suggesting that routine use may not be necessary if vitamin D levels are sufficient.

Osteoporosis after Kidney Transplantation

Calcitriol supplementation after kidney transplantation: results of a double-blinded, randomized, placebo-controlled trial. Khairallah P et al., J Bone Miner Res. 2025 May 24;40(5):603-616. doi: 10.1093/jbmr/zjaf044. PMID: 40089990; PMCID: PMC12103722.

Abstract

A significant number of kidney transplant recipients have low BMD. We hypothesized that calcitriol administration over the first year posttransplantation would protect the cortical skeleton in recipients managed without corticosteroids by suppressing PTH and bone remodeling. In this double-blind, placebo-controlled trial, 67 participants aged ≥18 yr on corticosteroid-sparing immunosuppressive regimen were randomized to daily calcitriol 0.5 μg or placebo for 12 mo after transplantation. The primary endpoint was the percent change in cortical density at the radius and tibia from pre- to postcalcitriol treatment compared to placebo as measured by HR-pQCT. Areal BMD was measured by DXA. Cortical and trabecular volumetric BMD and microarchitecture and total estimated bone strength were measured by HR-pQCT. Blood samples for bone metabolic markers were obtained at baseline, 1- and 12 mo. All primary analyses were intent to treat. Safety was assessed for hypercalcemia and progression of vascular calcifications. Thirty-two participants received calcitriol and 29 received placebo; 27 and 27 participants completed the study, respectively. Most participants were male and Caucasian. Baseline Z-scores at all sites were within 0.5 SD of the general population. At 12 mo posttransplantation, there were no between-group differences in areal BMD, volumetric BMD, microarchitecture or bone strength, or serum levels of bone markers. Participants with versus without bone loss had a blunted anabolic response over 12 mo measured by serum bone markers. Hypercalcemia was higher in the calcitriol group compared to placebo (p < .001). No changes in arterial calcification scores were observed. In this randomized placebo-controlled study of calcitriol administration in kidney transplant recipients on corticosteroid-sparing immunosuppression, calcitriol did not improve bone quality and strength but was associated with higher rates of hypercalcemia.

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Literature

Osteoporosis after kidney transplantation-no place for active vitamin D in the prevention of bone loss. Jørgensen HS, Evenepoel P. J Bone Miner Res. 2025 May 24;40(5):567-568. doi: 10.1093/jbmr/zjaf049. PMID: 40156932.

Bone Disease in Chronic Kidney Disease and Kidney Transplant. Bellorin-Font E, Rojas E, Martin KJ. Nutrients. 2022 Dec 29;15(1):167. doi: 10.3390/nu15010167. PMID: 36615824; PMCID: PMC9824497.