Discussion
renal failure, fractures, bone loss, ESRD
IMMUNOSUPPRESSION, RENAL FAILURE, ESRD, BONE LOSS
Bone strength can be described as the ability to resist fractures, which is based on bone quality as well as bone mass. The quality of the bone is affected by bone microarchitecture, geometry, and tissue material properties [Based on the findings of this study, the percentage of change in the spine and whole body BMD was significantly different between the patients who received zoledronic acid and those who were administered placebo; in patients who received placebo, these changes were negative, whereas those who received zoledronic acid showed positive changes. However, no significant difference was seen in the percentage of changes in the femur as a cortical bone [TBS is a textural index from spine DXA images that predict fractures independent of areal bone mineral density (BMD). A few studies have been conducted on how TBS is related to trabecular microarchitecture in patients with kidney transplant. In this study, no significant difference in TBS change was seen between the two groups. This result is in the same line with those of previous studies, which found that TBS did not provide clinically useful information regarding the effects of bisphosphonate on skeletal health [To the best of our knowledge, this is the first study to examine the impact of zoledronic acid on the bone geometric properties of the hip in kidney transplant patients. The present study showed a significant difference in the percentage of changes of subperiosteal diameter, endocortical diameter, and CSMI at the narrow neck between the cases and controls, and zoledronic acid appeared to enhance these parameters in comparison with placebo. This is in line with previous studies that showed the association of bisphosphonate with an improvement of geometry in the proximal femur [Supposing intact coupling, we anticipated that the zoledronic acid group would show decreased bone formation parameters as determined by alkaline phosphatase measurements and bone resorption [Because this intervention was implemented for both sexes, a wide range of ages, and different causes of ESRD, the findings can be attributed to men and women with a wide range of ages and underlying causes of renal failure leading to kidney transplantation; However, due to the relatively small sample size, the variability of the study population might affect the ability to detect a treatment effect and be considered as a potential limitation. An additional strength of this study, was that All participants were recruited at the same early time point after kidney transplantation. Additionally, it is important to note that with the advancements in Immunosuppression in kidney transplantation, there may be less bone loss expected [