Alendronate in combination with calcium and vitamin D prevents bone loss after orthotopic liver transplantation: a prospective single-center study.
Bone loss is a common complication in patients before and after liver transplantation (LT). The aim of this study was to investigate the efficacy of prophylactic treatment with bisphosphonates after LT in preventing progressive bone loss in LT patients. We included 136 patients with end-stage liver diseases awaiting LT. Bone mineral density (BMD) (by dual X-ray absorptiometry) and markers of bone metabolism were determined before, and 4, 12, 24, 36, and 48 months after LT. All patients received vitamin D and calcium supplementation before and after LT, those with osteopenia or osteoporosis prior to LT were additionally treated with alendronate following LT. Decreased BMD was seen in a high percentage of patients undergoing LT (osteopenia 48.5%, osteoporosis 23.5%). Reduced BMD before LT was not related to gender, underlying liver disease, or Child-Turcotte-Pugh classification. Body mass index (BMI) prior to LT, however, correlated significantly with the fracture risk. Alendronate prevented the ubiquitously observed bone loss after LT in patients with osteoporosis and osteopenia and, in addition, led to an increase in BMD in patients with osteoporosis within 24 months after LT. In conclusion, our study suggests that alendronate is efficacious in preventing the natural course of bone loss associated with LT.
Millonig
Gunda
G
Department of Gastroenterology and Hepatology, Innsbruck Medical University, Innsbruck, Austria.
Graziadei
Ivo W
IW
Eichler
Dagmar
D
Pfeiffer
Karl-Peter
KP
Finkenstedt
Gerd
G
Muehllechner
Petra
P
Koenigsrainer
Alfred
A
Margreiter
Raimund
R
Vogel
Wolfgang
W
D000328:Adult; D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000517:prevention & control*; D002118:Calcium / Q000627:therapeutic use*; D005260:Female; D005269:Femur / Q000378:metabolism; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000517:prevention & control; D011182:Postoperative Care; D011292:Premedication; D011446:Prospective Studies; D018570:Risk Assessment; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium; D019386:Alendronate