***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIMS To evaluate the effect of corticosteroids on  tacrolimus pharmacokinetics . METHODS In a r and omized trial , kidney transplant recipients were treated with tacrolimus and mycophenolate mofetil with either daclizumab ( n = 31 ) or 3 months of prednisone ( n = 34 ) .  Tacrolimus dose-adjusted predose concentrations ( C0 ) at month 1 - 6 were compared between both groups and within the corticosteroid group before and after prednisone withdrawal . RESULTS At month 1 the  tacrolimus dose-adjusted C0 in the corticosteroid group was 83 + /- 8 vs 119 + /- 17 ng ml-1 mg-1 kg-1 in the daclizumab group . The  tacrolimus dose-adjusted C0 within the corticosteroid group at month 1 and 2 was 42 % and 29 % lower compared with month 4 ( P < 0.001 ) . CONCLUSIONS A higher tacrolimus dose is required to reach target concentrations when used in combination with corticosteroids Safe withdrawal of corticosteroids or mycophenolate mofetil : results of a large , prospect i ve , multicenter , r and omized study . Squifflet JP , Vanrenterghem Y , van Hooff JP , Salmela K , Rigotti P ; European Tacrolimus/MMF Transplantation Study Group . Cliniques Universitaires Saint-Luc , University of Louvain Medical School , Saint Luc Hospital , 10 Hippocrates Avenue , B-1200 Brussels , Belgium . To compare the effects of deflazacort ( DEFLA ) vs. prednisone ( PRED ) on bone mineral density ( BMD ) , body composition , and lipids , 24 patients with end-stage renal disease were r and omized in a double blind design and followed 78 weeks after kidney transplantation .  BMD and body composition were assessed using dual energy x-ray absorptiometry . Seventeen patients completed the study .  Glucocorticosteroid doses , cyclosporine levels , rejection episodes , and drop-out rates were similar in both groups . Lumbar BMD decreased more in PRED than in DEFLA ( P < 0.05 ) , the difference being particularly marked after 24 weeks ( 9.1 + /- 1.8 % vs. 3.0 + /- 2.4 % , respectively ) . Hip BMD decreased from baseline in both groups ( P < 0.01 ) , without intergroup differences . Whole body BMD decreased from baseline in PRED ( P < 0.001 ) , but not in DEFLA . Lean body mass decreased by approximately 2.5 kg in both groups after 6 - 12 weeks ( P < 0.001 ) , then remained stable . Fat mass increased more ( P < 0.01 ) in PRED than in DEFLA ( 7.1 + /- 1.8 vs. 3.5 + /- 1.4 kg ) . Larger increases in total cholesterol ( P < 0.03 ) , low density lipoprotein cholesterol ( P < 0.01 ) , lipoprotein B2 ( P < 0.03 ) , and triglycerides ( P = 0.054 ) were observed in PRED than in DEFLA . In conclusion , using DEFLA instead of PRED in kidney transplant patients is associated with decreased loss of total skeleton and lumbar spine BMD , but does not alter bone loss at the upper femur . DEFLA also helps to prevent fat accumulation and worsening of the lipid profile UNLABELLED Osteoporosis is a frequent complication after renal transplantation . Some workers have shown that bisphosphonates may be effective to prevent and treat corticosteroid-induced osteoporosis in these patients . In this study we report our experience with administration of the biphosphonate alendronate to treat renal transplanted patients with established osteoporosis . MATERIAL S AND METHODS Twelve to 24 months after transplantation ( 9 women , 5 men ) 14 renal transplant patient were treated with alendronate and 12 patients ( 7 women , 5 men ) were untreated . All patients displayed an iPTH < 240 pg/mL and a bone mineral density ( BMD ) t-score < -2.5 . All patients received cyclosporine and prednisone therapy .  Biochemical measurements , BMD , and X-rays of the lumbar spine were measured during study . Patients in the treatment group received alendronate 10 mg/d ( po ) and vitamin D plus calcium ( 800 UI cholecalciferol and 2.5 g of CaCO(3 ) ) per day while those in the control group only received vitamin D plus calcium , at the same dose . RESULTS There was no difference in mean age , weight , time after transplantation , or immunosuppression between the treatment and control groups . There were no significant differences in the biochemical parameters during the study period . Over the 1-year study period , patients receiving alendronate displayed a greater increase in BMD . Lumbar spine BMD increased 4.3 + /- 6.1 % in the treatment group versus 0.55 + /- 5.30 % in controls . Femoral neck BMD increased 10.3 + /- 11.9 % and 2.2 + /- 5.7 % , respectively , in the treatment and control groups . Patients receiving alendronate frequently experienced intestinal disconfort . CONCLUSIONS The bisphosphonate alendronate is effective to treat renal transplant patients suffering from established osteporosis In this r and omized controlled trial started in October 1990 , 354 cadaveric kidney transplant recipients were assigned to receive either cyclosporine ( CsA ) monotherapy ( 115 patients ) , CsA + steroids ( 117 patients ) , or CsA + steroids + azathioprine ( 122 patients ) . The median follow-up was 85.1 mo . Thirty-one deaths occurred ( infection , 12 ; cardiovascular disease , 11 ; neoplasia , 4 ; and others , 4 ) , and 65 grafts were lost , mostly due to acute ( 15 ) or chronic rejection ( 50 ) . The cumulative graft half-life was 18.1 yr . According to the " intention-to-treat , " the 9-yr actuarial patient and graft survival were 94.0 % and 73.3 % , respectively , in monotherapy , 87.3 % and 65.9 % in dual therapy , and 87 % and 72.2 % in triple therapy ( P = 0.647 ) . At the last follow-up , the percentage of patients who remained with the original treatment was 51.2 % in monotherapy , 81.7 % in dual therapy , and 63.3 % in triple therapy . At the seventh year , the mean creatinine clearances were 54.9 + /- 17.6 ml/min in monotherapy , 57.9 + /- 23.4 in dual therapy , and 60.6 + /- 20.7 in triple therapy ( P = 0.375 ) . Cataracts ( P = 0.000 ) , osteoporosis ( P = 0.000 ) , and cardiovascular complications ( P = 0.000 ) were more frequent in dual or triple therapy than in monotherapy . Actuarial graft survival at 9 yr in patients on monotherapy who had to have steroids added was similar to that of the other two groups ( 62.2 % versus 69.3 % , P = 0.134 ) . In conclusion , actuarial patient and graft survivals did not differ among the three schemes . The long-term renal function and survival were not affected in the patients on monotherapy who needed the addition of steroids . Monotherapy was associated with a lower incidence of extrarenal complications than the other two regimens BACKGROUND Pamidronate is a second-generation bisphosphonate that has been used to attenuate post-renal transplant bone loss , but its effect on the function of the renal allograft is unclear . Therefore , we evaluated the long-term  renal function in 57 subjects who had participated in a prospect i ve , r and omized clinical trial using pamidronate to attenuate bone loss in the renal transplant recipient . METHODS Thirty subjects ( PAM ) received intravenous pamidronate , 60 mg at baseline post-transplant and 30 mg in months 1 , 2 , 3 and 6 post-transplant , while 27 subjects ( CON ) did not receive pamidronate . We followed renal function , need for renal replacement therapy following transplant rejection , and mortality for 3 years following the start of the original study . RESULTS PAM did not have increased incidence of renal dysfunction or mortality compared with CON at any time point during the 3 years of follow-up . The incidence of proteinuria was also not different between the two groups . CONCLUSIONS The prophylactic use of pamidronate in the above doses to attenuate bone loss in renal transplant recipients is not associated with higher incidence of renal dysfunction or mortality in a 3 year follow-up study . These findings may support the use of bisphosphonates in the treatment of early renal transplant-related bone loss 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 BACKGROUND Osteopenia is a major complication of renal transplantation .  Immunosuppressive regimens including cyclosporine , which permit the use of lower doses of glucocorticoids , may reduce glucocorticoid-induced osteopenia . METHODS We prospect ively studied the magnitude , distribution , and mechanism of bone loss in 20 adults who received renal allografts from living related donors , who had good renal function , and who were treated with azathioprine , cyclosporine , and low doses of prednisone .  We measured serum biochemical markers of bone metabolism , determined the bone mineral density of the second , third , and fourth lumbar vertebrae and the shaft of the radius , and analyzed the histomorphometric features of iliac bone at the time of transplantation and six months later . Measurements of vertebral mineral density were repeated 18 months after transplantation in 17 of the patients . RESULTS After transplantation , the mean serum concentrations of parathyroid hormone , phosphorus , and alkaline phosphatase decreased and the serum calcitriol concentration increased . The mean ( + /- SD ) bone mineral density of the vertebrae had decreased 6.8 + /- 5.6 percent 6 months after transplantation ( P less than 0.05 ) and 8.8 + /- 7.0 percent 18 months after transplantation . In contrast , the bone mineral density of the radius had increased six months after transplantation ( P less than 0.05 ) . The histomorphometric studies showed that the rate of bone formation decreased from 50.5 + /- 44.8 to 23.1 + /- 13.8 microns3 per square micrometer per year ( P less than 0.05 ) , and the formation period lengthened from 70 + /- 42 to 146 + /- 144 days ( P less than 0.05 ) . Consequently , the amount of bone replaced during a remodeling cycle diminished . CONCLUSIONS Osteopenia associated with renal transplantation remains 
    Output:
    
No individual intervention ( bisphosphonates , vitamin D sterol or calcitonin ) was associated with a reduction in fracture risk compared with placebo .
Bisphosphonates ( any route ) , vitamin D sterol , and calcitonin all had a beneficial effect on the bone mineral density at the lumbar spine .
Bisphosphonates and vitamin D sterol also had a beneficial effect on the bone mineral density at the femoral neck .
Bisphosphonates had greater efficacy for preventing bone mineral density loss when compared head-to-head with vitamin D sterols .
Treatment with a bisphosphonate , vitamin D sterol or calcitonin after kidney transplantation may protect against immunosuppression-induced reductions in bone mineral density and prevent fracture .