Evidence of continuing bone recovery at a mean of 7 years after liver transplantation.
Patients with end-stage liver disease have low bone-turnover osteoporosis, and there is often further bone loss of 20% to 30% after orthotopic liver transplantation (OLT). Bone recovery after OLT has been reported, but data are limited. We undertook studies to determine whether bone recovery continues in the long term. Twenty-eight adult patients alive at least 5 years after OLT were studied (14 men, 14 women). Bone mineral density (BMD), serum parathyroid hormone (PTH), osteocalcin, and vitamin D levels were measured pretransplantation, at 3 months, 12 months, a mean of 46 months, and a mean of 85 months (range, 63 to 117 months) after transplantation. When BMD is expressed as a z score, the results were as follows: x0.82 +/- 0.22 pre-OLT; -2.04 +/- 0.27 at 3 months; -1.68 +/- 0.24 at 12 months; -1.23 +/- 0.24 at a mean of 46 months; and -1.0 +/- 0.26 at a mean of 85 months after OLT. The results at 46 and 85 months were significantly greater than the measurement at 3 months after OLT (P <.05). Furthermore, mean BMD (expressed as a z score) returns to the pre-OLT level at a mean of 85 months. At final follow-up, 9 of 28 patients had elevated PTH levels, and 14 of 27 patients had elevated osteocalcin levels. Five patients had spontaneous fractures in the first 12 months after transplantation, and 5 more patients had fractures by final follow-up. Even at 7 years after OLT, there was a significant increase in BMD (expressed as a z score) compared with 3 months after transplantation. Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling.
Feller
R B
RB
A.W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
McDonald
J A
JA
Sherbon
K J
KJ
McCaughan
G W
GW
D000328:Adult; D000368:Aged; D015415:Biomarkers; D015519:Bone Density; D016723:Bone Remodeling; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D011863:Radioimmunoassay; D013739:Testosterone / Q000097:blood; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000097:blood
D015415:Biomarkers; D010281:Parathyroid Hormone; D015675:Osteocalcin; D014807:Vitamin D; D013739:Testosterone; D002118:Calcium