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The impact of ciclosporin on bone mineral metabo­ lism in renal transplanted patients is still debated. High serum levels of bone alkaline phosphatases and osteocal­ cin in ciclosporin-treated renal transplanted patients are reported by several authors, but the clinical meaning of this finding is controversial [1-3]. Some authors suggest that the rise of alkaline phosphatases and osteocalcin in ciclosporin-treated patients reflects an increase of both osteoblast activity and bone formation rate. Therefore, ciclosporin should exert a beneficial effect on bone min­ eralization [3] and/or a potential protection against the corticoid-induced osteoporosis [4], On the other hand, histomorphometric findings in man [5] and in rat [6] argue against the ‘increased repair hypothesis’, demonstrating a delayed healing of bone lesions in ciclosporin as com­ pared to azathioprine-treated renal transplanted pa­ tients. We studied 26 transplanted patients, 14 treated with ciclosporin and prednisolone (CS) and 12 treated with azathioprine and prednisolone (Aza). These two groups were homogeneous regarding age, sex, duration of trans­ plantation, plasma creatinine, and maintenance daily dose of prednisolone. Significantly higherserum alkaline phosphatase levels were observed in CS patients (230±55 vs. 160± 24 U /l; p<0.005). A sodium (150 mEq/day)and calcium (500 mg/day)-restricted diet was then given to all patients for 10 days. A reduced calcemic and calciuric response in the 4 h following an oral cal­ cium load (1 g) was observed in CS vs. Aza group [7]. These findings suggested the prevalence of a reduced intestinal calcium absorption and/or a high turnover osteopathy with ‘hungry bone condition' in the CS group. Fig. 1. Mean plasma activities (±SD) of ",7Ca at I and 2 h. expressed as percent of administered dose in 6 CS-treated renal transplanted patients (■. I h 30±2%, 2 h 27±3%), compared to 6 Aza-treated renal transplanted patients ( • , I h 29± 7%, 2 h 27± 4%) (p = NS).

/Ciclosporin and Calcium Metabolism in Renal Transplanted Patients