Zoledronic Acid Versus Alendronate for the Prevention of Bone Loss after Heart or Liver Transplantation

Context: The first year after transplantation is characterized by rapid bone loss. Objective: The aim of this study was to compare zoledronic acid (zoledronate) and alendronate for prevention of transplantation bone loss. Design and Setting: A randomized clinical trial was conducted at a transplantation center. Patients: The study included 84 adults undergoing heart or liver transplantation and a concurrently transplanted, nonrandomized reference group of 27 adults with T scores greater than −1.5. Interventions: Alendronate (70 mg weekly for 12 months) or one 5-mg infusion of zoledronate were both initiated 26 ± 8 d after transplantation. Main Outcome Measures: The primary outcome was total hip bone mineral density (BMD) 1 yr after transplantation. Secondary outcomes included femoral neck and lumbar spine BMD and serum C-telopeptide, a bone resorption marker. Results: In the reference group, BMD declined at the spine and hip (P < 0.001). In the randomized groups, hip BMD remained stable. Spine BMD increas...