Bone mineral density and bone microarchitecture evaluation in heart transplanted patients

Abstract

Heart transplant is recognized as the best treatment for refractory heart failure. With the improvement of survival of heart transplanted patients, a higher incidence of complications related to the procedure is observed, such as osteoporosis and its main complication, fragility fractures. The purpose of present study is to evaluate bone mineral loss, bone microarchitecture change and incidence of vertebral fractures after heart transplant. We will evaluate predictors of bone mineral loss and fractures to try to recognize patients at risk, who should be treated more aggressively to prevent osteoporosis, and avoid unnecessary treatment which can be accompanied by adverse events. We will include adult patients submitted to heart transplant in Instituto do Coração (Heart Institute - HCFMUSP) in a period of eighteen months. Exclusion criteria: age bellow 18 years-old at the time of transplant, mutiorgan transplant and retransplantation. We plan to include 40 patients.Methodology: Prospective observational study. The following data will be evaluated at times 0 (entry in the study), 6 and 12 months after transplant: 1) clinical and demographic data; 2) nutritional evaluation; 3) metabolic evaluation (including collect of exhaled air at time 0); 4) usual physical activity evaluation; 5) laboratorial evaluation, including bone metabolism biomarkers: P1NP (amino-terminal propeptide of type I collagen), CTX (C-terminal telopeptide of type I collagen), 25-hydroxyvitamin D, parathyroid hormone and sclerostin; 6) bone mineral density (DXA); 7) vertebral fracture evaluation by DXA; 8) evaluation of bone microarchitecture with high-resolution peripheral quantitative computed tomography (HRpQCT) XtremeCT (SCANCO Medical AG). (AU)