title: Relationship between immunosuppression and osteoporosis in an outpatient liver transplant clinic.
abstract: BACKGROUND
  The aim of this study is to determine the relationship between immunosuppression, disease state, and osteoporosis in an outpatient liver transplant clinic.
  
  
  METHODS
  All liver transplant recipients visiting an outpatient transplant clinic received bone density scanning with a dual-energy X-ray absorptiometry (DEXA) device of the calcaneal bone after completing a questionnaire assessing risk and medications currently being used.
  
  
  RESULTS
  Of the 137 liver transplant (OLT) recipients completing questionnaires and receiving DEXA screening, patients with low bone density (n = 50) were older (56.6 +/- 12.7 years vs 50.2 +/- 10.1 years; P = .02) compared with normal density patients (n = 87) and were predominately female (64.0% vs 35.6%; P = .01). Based on disease state, patients with cholestatic liver failure had lower bone calcaneal area (17.3 +/- 1.3 cm2 vs 18.9 +/- 1.57 cm2; P < .01). Patients taking tacrolimus (n = 112), as compared with cyclosporine (n = 25), had a tendency toward fewer findings of low bone density (37.5% [42 of 112] vs 56.0% [14 of 25]; P = .08) but had more risk factors (3.1 +/- 1.2 vs 2.1 +/- 0.8; P = .001) and a higher prednisone dose (4.4 +/- 5.9 mg/d vs 2.1 +/- 3.8 mg/d; P = .026). For patients weaned from prednisone, the tacrolimus patients were less likely to have low bone density (36.2% vs 68.8%; P = .02). Mycophenolate mofetil did not influence bone density or area measured.
  
  
  CONCLUSIONS
  After liver transplantation, patients taking cyclosporine were more likely to have low bone density compared with those taking tacrolimus.
authors.affiliation: Department of Pharmacy, Emory University Hospital, Atlanta, Georgia 30322, USA. greg_smallwood@emoryhealthcare.org
authors.forename: G A
authors.initials: GA
authors.lastname: Smallwood
authors.forename: D
authors.initials: D
authors.lastname: Burns
authors.forename: C G
authors.initials: CG
authors.lastname: Fasola
authors.forename: A C
authors.initials: AC
authors.lastname: Steiber
authors.forename: T G
authors.initials: TG
authors.lastname: Heffron
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D010045:Outpatients; D012016:Reference Values; D012307:Risk Factors; D012727:Sex Characteristics; D011795:Surveys and Questionnaires