title: Bone density and metabolism in patients with viral hepatitis and cholestatic liver diseases before and after liver transplantation.
abstract: OBJECTIVE
  Osteoporosis is frequently found in patients with cholestatic liver disease (primary biliary cirrhosis/primary sclerosing cholangitis) and chronic viral hepatitis. There is limited information about the long-term effect of liver transplantation (OLT) on bone metabolism. The aim of this study was to investigate the effect of liver transplantation on bone metabolism in patients with cholestatic and viral liver diseases.
  
  
  METHODS
  We randomly recruited 193 patients with chronic viral hepatitis or cholestatic liver diseases. Bone density (Z-score) and markers of bone metabolism (intact parathyroid hormone [iPTH], PTH 70-84, osteocalcin, procollagen, telopeptide, and vitamin D) were determined before and at time points (< and > 24 months) post-OLT.
  
  
  RESULTS
  Before OLT, bone density (Z-score) was decreased in patients with cholestatic (-1) and viral (-0.4) liver diseases. In both groups bone density continued to decrease in the periods up to and more than 24 months after OLT. In the cholestatic group, bone density decreased significantly compared to pre-OLT (p < 0.05) and to the viral hepatitis group (p < 0,001). Markers of bone metabolism showed that after OLT, bone metabolism was enhanced and shifted versus bone resorption. Immunosuppressive drug therapy (glucocorticoids, cyclosporin, FK 506) directly correlated with increased bone metabolism post-OLT.
  
  
  CONCLUSIONS
  Bone loss is a long-term problem after OLT, particularly in patients with cholestatic liver diseases. Drug therapy is a main factor of bone loss. Pre- and post-OLT therapy to reduce bone loss is recommended.
authors.affiliation: Department of Gastroenterology and Hepatology, Medizinische Hochschule, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Trautwein
authors.forename: M
authors.initials: M
authors.lastname: Possienke
authors.forename: H J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: K H
authors.initials: KH
authors.lastname: Böker
authors.forename: R
authors.initials: R
authors.lastname: Horn
authors.forename: R
authors.initials: R
authors.lastname: Raab
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
authors.forename: G
authors.initials: G
authors.lastname: Brabant
mesh_terms: D000328:Adult; D015415:Biomarkers; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D002779:Cholestasis / Q000378:metabolism* / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006525:Hepatitis, Viral, Human / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D000637:Transaminases / Q000097:blood
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D010710:Phosphates; D000637:Transaminases; D002118:Calcium