Bone mineral density in the long term after liver transplantation.
Hepatic osteodystrophy is a complication of chronic liver disease and bone mass is known to decline further in the first year after liver transplantation. The present study focused on bone mineral density (BMD) between 1 and 15 years after liver transplantation under a prednisolone- and azathioprine-based immunosuppressive regimen. Three groups of adult patients were studied: group 1, 45 patients with a follow-up of 5-9 years after transplantation, had BMD measurements done at 1, 2 and 5 years after transplantation; group 2, 17 patients with a follow-up of 10-14 years, had BMD measurements done at 5 and 10 years; group 3, 4 patients with a follow-up of more than 15 years, had BMD measurements done at 10 and 15 years. BMD of lumbar spine (L1-L4) and proximal femur was measured using dual-energy X-ray absorptiometry, and at the same time radiographs of the spine and hips were made. Spinal BMD increased significantly, during the second post-transplant year; subsequently no significant changes were seen. Proximal femur BMD decreased slightly, but significantly during the second year, and remained stable afterwards. About one-third of patients had a BMD below the fracture threshold (= 0.798 g/cm2 for the lumbar spine and 0.675 g/cm2 for the hip) during the follow-up. In 5 of the 66 patients studied, new vertebral fractures occurred. No fractures or avascular necrosis of the hips were seen. Furthermore, after transplantation lower Z-scores of the hip were found in patients with pre-transplant cholestatic liver diseases, and lower Z-scores of the lumbar spine were found in men compared with women. Long-term follow-up of BMD up to 15 years after transplantation revealed an improvement mainly in the second postoperative year with no deterioration afterwards. Nevertheless a substantial number of patients (around one-third) kept a BMD below the fracture threshold, and new fractures may occasionally occur. The overall outcome appeared somewhat less favorable in men and patients transplanted for cholestatic liver diseases.
Hamburg
S M
SM
Department of Gastroenterology and Hepatology, University Hospital, Groningen, The Netherlands.
Piers
D A
DA
van den Berg
A P
AP
Slooff
M J
MJ
Haagsma
E B
EB
D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D001379:Azathioprine / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D002118:Calcium / Q000627:therapeutic use; D012968:Etidronic Acid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology; D011239:Prednisolone / Q000009:adverse effects; D012737:Sex Factors
D000893:Anti-Inflammatory Agents; D000963:Antimetabolites; D005938:Glucocorticoids; D006887:Hydroxycholecalciferols; D007166:Immunosuppressive Agents; D011239:Prednisolone; D012968:Etidronic Acid; D001379:Azathioprine; D002118:Calcium