title: Predominant factors associated with bone loss in liver transplant patients - after prolonged post-transplantation period.
abstract: BACKGROUND
  Osteoporosis is a major cause of morbidity in liver transplant recipients and is associated with multiple factors.
  
  
  OBJECTIVE
  To evaluate bone mineral density (BMD), bone turnover and calcium-regulating hormones in 29 patients (17 men, 12 women) 2-12 yrs following liver transplantation for non-alcoholic liver diseases.
  
  
  RESULTS
  Fifteen patients (52%) were on immunosuppressive treatment with tacrolimus and 14 (48%) with cyclosporine. Eleven patients (38%) were currently on prednisone, 18 patients (62%) had stopped glucocorticoid treatment 6 months to 11 yrs prior to the study. Nineteen patients (65.5%) had decreased BMD according to WHO criteria, 17 (58.2%) at the femoral neck, 13 (44.8%) at the lumbar spine. Nineteen patients (65.5%) had a subnormal (<15 ng/mL) serum level of 25 (OH) D3. These patients had significantly lower BMD at the femoral neck (p = 0.02). Femoral neck BMD negatively correlated with serum parathyroid hormone level (p = 0.06, r = -0.35), length of the post-transplantation period (p = 0.025, r = -0.416) and duration of glucocorticoid treatment (p = 0.029, r = -0.406), regardless of its cumulative dose. Symptomatic fractures were less frequent in tacrolimus treated patients than in cyclosporine users (p = 0.03).
  
  
  CONCLUSIONS
  Decreased BMD is frequent following liver transplantation and is affected by vitamin D deficiency, cyclosporine use, and the duration of glucocorticoid therapy, but not by its cumulative dose. Achievement and maintenance of optimal vitamin D status and shortening of glucocorticoid treatment period may have a favorable effect on bone preservation.
authors.affiliation: Metabolic Bone Diseases Unit, Rambam Medical Center, Haifa, Israel.
authors.forename: Elena
authors.initials: E
authors.lastname: Segal
authors.forename: Yakov
authors.initials: Y
authors.lastname: Baruch
authors.forename: Rimma
authors.initials: R
authors.lastname: Kramsky
authors.forename: Batia
authors.initials: B
authors.lastname: Raz
authors.forename: Ada
authors.initials: A
authors.lastname: Tamir
authors.forename: Sophia
authors.initials: S
authors.lastname: Ish-Shalom
mesh_terms: D015502:Absorptiometry, Photon; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000652:urine; D015519:Bone Density; D016723:Bone Remodeling / Q000502:physiology*; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D010281:Parathyroid Hormone / Q000097:blood; D012044:Regression Analysis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D000596:Amino Acids; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D016572:Cyclosporine; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase; D016559:Tacrolimus