Change in bone mineral density at one year following glucocorticoid withdrawal in kidney transplant recipients

Glucocorticoid (GC) therapy induces deleterious effects on the skeleton in kidney transplantation but studies of GC discontinuation in this population are limited. This study evaluated changes in areal bone mineral density (BMD) with GC withdrawal. Subjects were enrolled one yr after renal transplantation and randomized to continue or stop prednisone; all subjects continued cyclosporine and mycophenolate mofetil. BMD measured by dual-energy X-ray absorptiometry was performed at enrollment and repeated at one yr and values were standardized. Mean +/- standard deviation of annualized change in standardized BMD between GC withdrawal vs. continuation group at the lumbar spine was +4.7% +/- 5.5 vs. +0.9% +/- 5.3 (p = 0.0014); total hip +2.4% +/- 4.2 vs. -0.4% +/- 4.2 (p = 0.013), and femoral neck +2.1% +/- 4.6 vs. +1.0% +/- 6.0 (p = 0.37). There was no confounding by prednisone dose prior to enrollment, change in creatinine clearance, weight, or use of bone-active medications following study entry. Multivariate analysis determined that the change in BMD was positively associated with baseline alkaline phosphatase and creatinine clearance and negatively associated with baseline BMD. BMD improves with GC withdrawal after renal transplantation, and this gain in BMD is dependent on the baseline bone turnover, renal function, and BMD.