Is there cyclosporine-induced bone disease?

Considerable controversy remains concerning the effect of cyclosporine on bone. One effect of this agent is to increase bone turnover, favoring resorption of bone. This effect is best illustrated in animal models. Contradictory animal evidence suggests that this effect is seen only at otherwise toxic doses of cyclosporine. Human studies also are contradictory, but most animal and human studies do suggest that concern about a potentially deleterious effect of cyclosporine on bone is warranted. Presently, there seems to be no agent to counter these adverse effects. Although not proven, general bone health recommendations should be followed for patients started on cyclosporine; measures include adequate dietary calcium and vitamin D intake, weight bearing as soon as possible, hormone replacement for women who are hypogonadal and for men who are hypogonadal and taking steroids, avoidance of loop diuretics and encouraged thiazide use, discontinuation of harmful habits/lifestyle, and recognition of concomitant bone and mineral disorders.