Renal Transplant Recipients (RTRs) are at risk of developing osteoprosis and osteopenia due to underlying renal osteodystrophy, hypophosphatemia, and immuno­supresstion. It is more frequent in the first year after renal transplantation but can be continued by the time after transplantation (RTX) that result in bone loss and fractures. The purpose of this study was to evaluate the effect of low dose intravenous pamidronate in prevention of late bone loss after RTX. We prospectively studied 40 RTRs (M=20, F=20) with mean age of 38/05 ± 13.93, mean BMI: 24.1 ± 4.73, mean dialysis duration of 24.98 ± 17.67 and assigned them in two age & sex match groups: Pamidronate treated (Pam) group received Vit D during the study and 0.5 mg/kg intravenous pamidronate at the time and one month after RTX, and control group received only Vit D. We measured serum calcium, phosphate, Alkaline phosphatase, blood urea & creatinine at baseline & monthly and iPTH & BMD at baseline and 3 & 6 months after RTX and every 6 month to 2 years. Lumbar BMD in Pam group increased significantly from 0.827 ± 0.11 to 0.857 ± 0.12, (p<0.01) & decreased in control group from 0.900 ± 0.16 to 0.812 ± 0.11, (p<0.001) 6 month after RTX. There was also significant increase of radius BMD (p<0.001) & non significant increase of femur BMD in Pam & and significant decrease of BMD of femur & radius (p<0.001) in control group 6 month after RTX. After 2 years there was significant reduction in BMD of spine control group comparing pam group (p<0.01).T & Z score of spine & femur significantly decreased (p<0.001) in control group comparing Pam group (p<0.001) 2 years after RTX. After multivariate analysis there was significant correlation between pamidronate & BMD of spine, (r=0.41, p<0.001) but there was not any linear regression between age, sex, BMI, duration of dialysis & iPTH with BMD changes of femur & spine & radius after 2 years in each groups. In conclusion., low dose pamidronate is significantly useful in prevention of long term bone loss and can increase the BMD even late period after RTX.