Long-term persistence of low bone density in orthotopic liver transplantation.
We determined bone density and metabolism in 46 patients (35 males, 11 females) who had undergone liver transplantation 1-48 months previously. Twenty-one patients were then followed for the next 24 months. At each visit, blood and urine samples for bone and liver metabolism parameters, as well as spinal and femoral dual-energy X-ray absorptiometry (DXA) scans, were obtained. Basal spinal and femoral density was low (p < 0.001). Patients with pre-transplant cholestatic diseases had lower spinal density than all the other subjects (p <0.05) and the cumulative methylprednisolone intake was an independent negative predictor of total hip density (p < 0.02). At baseline, urinary hydroxyproline and N-telopeptide were at the upper normal level and decreased only after 24 months of follow-up (p < 0.05). During the first year of follow-up, femoral density decreased (p < 0.05) and a partial recovery was observed for both spine and femur after 24 months. After 12 months, femoral bone density was negatively associated with serum cyclosporin A levels (p < 0.005) and cumulative methylprednisolone intake (p < 0.05), while the percent decrease in spinal density after the first 12 months was negatively predicted by mean daily methylprednisolone intake (p < 0.05). In patients with pre-transplant cholestatic diseases, femoral and spinal density increased after the first (p < 0.05) and second year (p < 0.05), respectively. In patients with previous post-necrotic cirrhosis, femoral density decreased after 12 months (p<0.05) and was still lower than baseline after 24 months (p < 0.05). However, at the end of the study the cumulative percentage of femoral neck osteoporosis was 43%. In conclusion, an elevated prevalence of spinal and femoral osteoporosis is present even many years after liver transplantation, with immunosuppressive treatment and pre-transplant liver disease being the most important pathogenetic factors.
Department of Medical and Surgical Sciences, University of Padua and National Research Council, Centre for Aging Studies of Padua, Italy. giannini@ux1.unipd.it
S
S
Giannini
M
M
Nobile
M
M
Ciuffreda
R M
RM
Iemmolo
L
L
Dalle Carbonare
N
N
Minicuci
F
F
Casagrande
C
C
Destro
G E
GE
Gerunda
L
L
Sartori
G
G
Crepaldi
D000328:Adult; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005269:Femur / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008107:Liver Diseases / Q000150:complications; D016031:Liver Transplantation / Q000502:physiology*; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D013997:Time Factors
D015415:Biomarkers; D007166:Immunosuppressive Agents