Bone mineral disease in children after renal transplantation in steroid-free and steroid-treated patients – a prospective study Successful renal transplantation corrects many of the metabolic abnormalities present during the pretransplant period in children with end- stage renal disease. Bone disease constitutes one of the pathologies which may persist after transplantation despite good renal graft func- tion. However, data on the incidence and severity of this problem are conflicting (1) and there is concern about appropriate interpretation of bone mineral density (BMD) examination results in children and adolescents after renal transplantation (2, 3). The mechanism of post- transplant bone disease combines the existing pretransplant pathologies, such as hyperpara- thyroidism or adynamic bone disease, with adverse effects of post-transplant maintenance immunosuppression (4). A variety of pharmaco- logic and surgical interventions have been used to prevent or treat post-transplant bone loss both in adult and pediatric populations, includ- ing vitamin D, nasal spray calcitonin, oral or intravenous bisphosphonates, and parathyroi- dectomy (5–8). Although there is some evidence of a beneficial effect of these strategies, there is Grenda R, Karczmarewicz E, Rubik J, Matusik H, Pl udowski P, Kiliszek M, Piskorski J. Bone mineral disease in children after renal transplantation in steroid-free and steroid-treated patients – a pro- spective study. Pediatr Transplantation 2011: 15: 205–213. Ó 2010 John Wiley & Sons A/S. Abstract: Bone disease may persist after transplantation. Different approaches aiming to ameliorate this problem have been investigated. The aim of the study was to compare the long-term effect of three medical interventions: (i) two prophylactic oral doses of 50 mg ibandronate; (ii) daily oral dose of 0.25 lg of 1a-OHD3 (both of these regimens in patients receiving steroids), and (iii) steroid minimization immunosuppressive protocol in patients with no other specific prophylaxis. Patients: A total of 37 children, at a mean age of 13.33 ± 3.49 yr, dialyzed for 15.93 ± 16.7 months before transplan- tation, were divided into three groups, depending on medical inter- vention. Bone mineral content and density (BMC, BMD, DXA), serum markers of bone resorption and formation (CTX, P1NP), calcium, phosphate, 25OHD3/1.25 (OH)2D3 and PTH concentration were evaluated during two yr of follow-up. The mean values of BMD in the whole population and among the three subgroups remained within the age- and gender-matched normal range during follow-up. Patients from groups II (alphacalcidiol) and III (steroid minimization) showed a significant decrease in BMD Z-scores over time, and this effect was determined with increasing age using multivariate analysis. Patients receiving two doses of ibandronate maintained unchanged Z-scores for BMD and BMC over time. Ryszard Grenda 1 , El _ zbieta Karczmarewicz 2 , Jacek Rubik 1 , Halina Matusik 2 , Pawel Pl udowski 2 , Mal gorzata Kiliszek 1 and Jarosl aw Piskorski 3 1 Department of Nephrology, Kidney Transplantation and Hypertension, 2 Department of Biochemistry and Experimental Medicine, The ChildrenÕs Memorial Health Institute, Warsaw, 3 Institute of Physics, University of Zielona Gora, Zielona Gora, Poland Key words: renal transplantation – bone disease – prophylaxis – steroid minimization Ryszard Grenda, Department of Nephrology, Kidney Transplantation and Hypertension, The ChildrenÕs Memorial Health Institute, Aleja Dzieci Polskich 20, 04–730 Warsaw, Poland Tel.: +48 22 815 1540 Fax: +48 22 815 1541 E-mail: r.grenda@czd.pl Accepted for publication 29 October 2010 Abbreviations: AIC, Akaike information criterion; AP, alkaline phosphatase; CTx, Collagen Type I Crosslinked C- telopeptide; B-CrossLaps (CTX), B-CrossLaps Carboxy (C) terminal telopeptide; CsA, cyclosporine A; Dac, dac- lizumab; DXA, dual energy X-ray absorptiometry; eGFR, estimated glomerular filtration rate; MMF, mycophenolate mofetil; P1NP, procollagen I aminoterminal propeptide; Pred, prednisone; PTH, parathyroid hormone; SBBMC, lumbar spine bone mineral content; SBBMD, lumbar spine bone mineral density; SIR, sirolimus; TAC, tacrolimus; TBBMC, total body bone mineral content; TBBMD, total body bone mineral density. Pediatr Transplantation 2011: 15: 205–213 Ó 2010 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/j.1399-3046.2010.01448.x 205