***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Kidney transplantation is associated with an increased risk of bone fracture and rapid loss of bone mineral density after kidney transplantation . STUDY DESIGN R and omized controlled trial . SETTING & PARTICIPANTS Patients were r and omly assigned to treatment ( n = 46 ) or control ( no treatment ; n = 47 ) groups . Patients were stratified according to parathyroid hormone level and sex . Those with parathyroid hormone level less than 150 pg/mL were excluded . INTERVENTION The treatment and control groups received pamidronate , 1 mg/kg , perioperatively and then at 1 , 4 , 8 , and 12 months or no treatment , respectively . All received calcium ( 500 mg ) and vitamin D ( 400 units ) daily . Immunosuppression was cyclosporine and prednisolone , with no difference in dosing between the 2 groups . OUTCOMES & MEASUREMENTS Bone mineral density was evaluated by means of dual-energy x-ray absorptiometry of the lumbar spine and hip at baseline and 3 , 6 , 12 , and 24 months , with the primary end point at 1 year of percentage of change in bone mineral density from baseline . Clinical fractures were recorded and also evaluated by means of spinal radiographs at baseline and 1 and 2 years . RESULTS Pamidronate protected bone mineral density at the lumbar spine ; bone mineral density increased by 2.1 % in the treatment group and decreased by 5.7 % in the control group at 12 months ( P = 0.001 ) . Protection was also seen in Ward 's area of the hip ( P = 0.002 ) and the total hip ( P = 0.004 ) . There was no difference in femoral neck bone mineral density loss between the 2 groups . Fracture rates in the treatment and control groups were 3.3 % and 6.4 % per annum , respectively . LIMITATIONS This study was not powered to detect differences in fracture rates . CONCLUSION Pamidronate protects against posttransplantation bone loss at the lumbar spine and Ward 's area of the hip Severe osteoporosis frequently is observed after organ transplantation . In kidney transplantation , it adds to pre-existing renal bone disease and strategies to prevent osteoporosis are not established . Eighty kidney recipients were included in a r and omized controlled prospect i ve intervention trial . Treated patients ( n = 40 ) received an injection of ib and ronate , a bisphosphonate , immediately before and at 3 , 6 , and 9 mo after transplantation . The primary outcome measured was the change in bone mineral density . Secondary measures included graft outcome , spinal deformities , fracture rate , body height , and hormonal and metabolic data . Loss of spongy and cortical bone after transplantation was prevented by ib and ronate .  Changes of bone mineral density ( ib and ronate versus controls ) were as follows : lumbar spine , -0.9 + /- 6.1 % versus -6.5 + /- 5.4 % ( P < 0.0001 ) ; femoral neck , + 0.5 + /- 5.2 % versus -7.7 + /- 6.5 % ( P < 0.0001 ) ; and midfemoral shaft , + 2.7 + /- 12.2 % versus -4.0 + /- 10.9 % ( P = 0.024 ) . Fewer spinal deformities developed with ib and ronate ( 7 patients with 7 deformities versus 12 patients with 23 deformities ; P = 0.047 ) . Loss of body height was 0.5 + /- 1.0 cm versus 1.1 + /- 1.0 cm in control subjects ( P = 0.040 ) . Two bone fractures occurred in each group . There were fewer acute rejection episodes with ib and ronate ( 11 versus 22 ; P = 0.009 ) . Graft function after 1 yr was comparable . Bone loss , spinal deformation , and loss of body height during the first year after kidney transplantation are prevented by injection of ib and ronate at intervals of 3 mo . The smaller number of rejection episodes of the ib and ronate-treated group should be confirmed and its mechanism should be explored in additional studies The clinical profile of ib and ronate as add‐on to calcitriol and calcium was studied in this double‐blind , placebo‐controlled trial of 129 renal transplant recipients with early stable renal function ( ≤ 28 days posttransplantation , GFR ≥ 30 mL/min ) . Patients were r and omized to receive i.v . ib and ronate 3 mg or i.v . placebo every 3 months for 12 months on top of oral calcitriol 0.25 mcg/day and calcium 500 mg b.i.d . At baseline , 10 weeks and 12 months bone mineral density ( BMD ) and biochemical markers of bone turnover were measured . The primary endpoint , relative change in BMD for the lumbar spine from baseline to 12 months was not different , + 1.5 % for ib and ronate versus + 0.5 % for placebo ( p = 0.28 ) . Ib and ronate demonstrated a significant improvement of BMD in total femur , + 1.3 % versus −0.5 % ( p = 0.01 ) and in the ultradistal radius , + 0.6 % versus −1.9 % ( p = 0.039 ) . Bone formation markers were reduced by ib and ronate , whereas the bone resorption marker , NTX , was reduced in both groups . Calcium and calcitriol supplementation alone showed an excellent efficacy and safety profile , virtually maintaining BMD without any loss over 12 months after renal transplantation , whereas adding ib and ronate significantly improved BMD in total femur and ultradistal radius , and also suppressed biomarkers of bone turnover . Ib and ronate was also well tolerated The aim of this study was to investigate the effects of alendronate , calcitriol , and calcium in bone loss  after kidney transplantation . We enrolled 40 patients ( 27 men and 13 women , aged 44.2 + /- 11.6 years ) who had received renal allograft at least 6 months before ( time since transplant , 61.2 + /- 44.6 months ) . At baseline , parathyroid hormone ( PTH ) was elevated in 53 % of the patients and the Z scores for bone alkaline phosphatase ( b-ALP ) and urinary type I collagen cross-linked N-telopeptide ( u-NTX ) were higher than expected ( p < 0.001 ) . T scores for the lumbar spine ( -2.4 + /- 1.0 ) , total femur ( -2.0 + /- 0.7 ) , and femoral neck ( -2.2 + /- 0.6 ) were reduced ( p < 0.001 ) . After the first observation , patients were advised to adhere to a diet containing 980 mg of calcium daily and their clinical , biochemical , and densitometric parameters were reassessed 1 year later . During this period , bone density decreased at the spine ( -2.6 + /- 5.7%;p < 0.01 ) , total femur ( -1.4 + /- 4.2 % ; p < 0.05 ) , and femoral neck ( -2.0 + /- 3.0 % ; p < 0.001 ) . Then , the patients were r and omized into two groups : ( 1 ) group A-10 mg/day of alendronate , 0.50 microg/day of calcitriol , and 500 mg/day of calcium carbonate ; and ( 2 ) group B-0.50 microg/day of calcitriol and 500 mg/day of calcium carbonate . A further metabolic and densitometric reevaluation was performed after the 12-month treatment period . At the r and omization time , group A and group B patients did not differ as to the main demographic and clinical variables . After treatment , bone turnover markers showed a nonsignificant fall in group B patients , while both b-ALP and u-NTX decreased significantly in alendronate-treated patients . Bone density of the spine ( + 5.0 + /- 4.4 % ) , femoral neck ( + 4.5 + /- 4.9 % ) , and total femur ( + 3.9 + /- 2.8 % ) increased significantly only in the alendronate-treated patients . However , no trend toward further bone loss was noticed in calcitriol and calcium only treated subjects . No drug-related major adverse effect was recorded in the two groups . We conclude that renal transplanted patients continue to loose bone even in the long-term after the graft . Alendronate normalizes bone turnover and increases bone density . The association of calcitriol to this therapy seems to be advantageous for better controlling the complex abnormalities of skeletal metabolism encountered in these subjects We performed a prospect i ve , r and omized , double-blind study to determine whether calcium and calcitriol prevents posttransplant bone loss .  Thirty-eight nondiabetic and 26 diabetic patients without prior steroid exposure undergoing their first kidney or kidney-pancreas transplant were r and omized to calcium , calcium plus calcitriol , or placebo .  Lumbar spine ( LS ) , femoral neck ( FN ) , and distal radius ( DR ) bone mineral density scans ( BMDs ) were obtained at baseline , 6 , and 12 months . At 1 year , patients treated with placebo experienced a 2 % decline in BMD at the LS and DR and a 1.3 % increase at the FN . In contrast , patients treated with calcium and vitamin D had a 0.1 % decline at the LS and 2.9 % and 4.8 % increases at the DR and FN , respectively . Patients receiving cyclosporine  had more bone loss than those receiving tacrolimus . Our results demonstrate a small therapeutic effect of calcium and calcitriol and suggest that tacrolimus is less osteotoxic than cyclosporine Bisphosphonates may prevent or treat the bone loss promoted by the immunosuppressive regimens used in renal transplantation .  Risedronate is a commonly used third-generation amino-bisphosphonate , but little is known about its effects on the bone health of renal transplant recipients . We r and omly assigned 42 new living-donor kidney recipients to either 35 mg of risedronate weekly or placebo for 12 months . We obtained bone biopsies at the time of renal transplant and after 12 months of protocol treatment . Treatment with risedronate did not affect bone mineral density ( BMD ) in the overall cohort . In subgroup analyses , it tended to preserve BMD in female participants but did not significantly affect the BMD of male participants .  Risedronate did associate with increased osteoid volume and trabecular thickness in male participants , however . There was no evidence for the development of adynamic bone disease . In summary , further study is needed before the use of prophylactic bisphosphonates to attenuate bone loss can be recommended in renal transplant recipients BACKGROUND Very rapid bone loss , osteopenia and skeletal morbidity after renal transplantation have been well documented and found to occur in a sex dependent fashion . Glucocorticoids , cyclosporine and pre-existing uremic osteodystrophy have been implicated in the pathogenesis of the skeletal lesions . Glucocorticoid induced osteopenia is also a serious clinical problem in patients with various nonrenal diseases and can be prevented , or at least attenuated , by pamidronate and other bisphosphonates . METHOD We prospect ively studied 26 male patients undergoing renal transplantation , and r and omized them to receive either placebo or intravenous pamidronate ( 0.5 mg/kg ) at the time of transplantation and again one month later . All patients received immunosuppression comprising prednisolone , cyclosporine and azathioprine . The bone mineral density ( BMD ) of the second , third and fourth lumbar vertebrae and of the femoral neck was measured at the time of transplantation and at three months and 12 months after transplantation using dual energy X-ray absorptiometry ( DXA ) . RESULTS Twelve months after transplantation , the mean ( + /- SEM ) BMD of the lumbar vertebrae in patients who received placebo had decreased 6.4 % ( P < 0.05 ) . In contrast , patients who received pamidronate experienced no significant reduction of BMD at the lumbar vertebrae . At the femoral neck , placebo-treated patients showed a reduction of BMD of 9 % ( P < 0.005 ) , whereas there was no significant change in the pamidronate treated group . The two study groups had similar patient profiles , serum parathyroid hormone ( PTH ) and aluminium concentrations . After transplantation , comparable falls in the serum creatinine and PTH concentration were found in the two groups . Apart from transient hypocalcemia in two patients , no significant adverse effects of pamidronate were noted . CONCLUSION This study has shown that the early rapid bone loss that occurs in men during the first 12 months after renal transplantation can be prevented by two intravenous doses of pamidronate given at transplantation and one month later . The regimen was simple to administer , well tolerated and potentially applicable to other clinical groups of glucocorticoid treatment patients BACK 
    Output:
    
Conclusions Our study suggested that additional use of bisphosphonate was well-tolerated and more favorable in KTRs to improve BMD