Lack of effect of intravenous pamidronate on fracture incidence and bone mineral density after orthotopic liver transplantation.
OBJECTIVE
Increased rates of bone loss and fracture have been reported after liver transplantation. The aim of this study was to investigate the effects of a pre-transplant infusion of pamidronate on fracture incidence and bone loss during the first year after transplantation.


METHODS
Ninety-nine adults awaiting orthotopic liver transplantation (OLT) were randomised to pamidronate or no treatment. Spinal X-rays were obtained at baseline and after 12 months. Bone mineral density (BMD) was measured at the lumbar spine (L1-4) and femoral neck at baseline, and 3, 6, and 12 months after OLT.


RESULTS
The incidence of fractures in the first year after OLT was 8%, four patients within the pamidronate treated group and two in the untreated group developing fractures (P=0.40). No significant spinal bone loss occurred in either group during the first year. However, significant and sustained bone loss occurred at the femoral neck in both groups. No significant differences were seen between pamidronate treated or untreated groups at either site.


CONCLUSIONS
Pamidronate in the regimen used had no significant effect on fracture rate or BMD post-transplant. The low incidence of fracture and absence of spinal bone loss indicate that bone disease after liver transplantation may be less common than previously reported.
Ninkovic
Mary
M
Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
Love
Shirley
S
Tom
Brian D M
BD
Bearcroft
Philip W P
PW
Alexander
Graeme J M
GJ
Compston
Juliet E
JE
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015519:Bone Density; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology; D000077268:Pamidronate; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology; D016103:Spinal Fractures / Q000188:drug therapy* / Q000453:epidemiology; D017211:Treatment Failure
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D000077268:Pamidronate