Regional bone mineral density after orthotopic liver transplantation.
OBJECTIVE
Although there is a fall in lumbar spine bone mineral density (BMD) after liver transplantation, little is known about femoral neck or total body BMD. Therefore we determined: (a) the proportion of patients with preexisting hepatic osteopenia before transplantation and (b) the effects of transplantation on global and regional BMD.


METHODS
Retrospective analysis of BMD measurements of patients before and up to 2 years after liver transplantation.


METHODS
BMD was assessed by dual energy X-ray absorptiometry in 56 patients, before and at regular intervals after liver transplantation, for up to 24 months, to measure total body, lumbar spine (L2-L4) and femoral neck BMDs.


RESULTS
Pre-transplant, 23% of patients had osteoporosis (a negative Z score > 2). Paired data before and after transplantation revealed no change in total body BMD. However, there was a fall in lumbar spine BMD (1.04+/-0.03 to 1.02+/-0.03 g/cm2; P < 0.04) at 1 month after transplantation. The reduction in lumbar spine BMD was seen up to 12 months, BMD at 18-24 months being similar to pre-transplant values. Femoral neck BMD also fell (0.96+/-0.06 to 0.83+/-0.04 g/cm2; P < 0.03), but only after 6-9 months, thereafter remaining below pre-transplant values until the end of the follow-up period.


CONCLUSIONS
Although osteopenia is common in patients with liver disease, total bone density does not fall after transplantation. Nonetheless regional lumbar spine and femoral neck bone density does fall after transplantation with a risk period for femoral neck fracture which may extend for up to 2 years.
Hussaini
S H
SH
Academic Division of Medicine and Centre for Hepatobiliary Diseases, St James's University Hospital, Leeds, UK. hyder.h@netcomuk.co.uk
Oldroyd
B
B
Stewart
S P
SP
Roman
F
F
Smith
M A
MA
Pollard
S
S
Lodge
P
P
O'Grady
J G
JG
Losowsky
M S
MS
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000628:therapy; D002779:Cholestasis / Q000150:complications / Q000601:surgery; D005260:Female; D005265:Femoral Neck Fractures / Q000209:etiology; D005272:Femur Neck / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000601:surgery; D017093:Liver Failure / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors