Effect of chronic glucocorticoid therapy and the gender difference on bone mineral density in liver transplant patients.
BACKGROUND
Chronic glucocorticoid therapy (CGT) has been shown to result in bone density loss causing osteoporosis. Patients undergoing liver transplantation (LT) are on CGT and are at increased risk for bone disease. To further study the relationship between CGT and bone loss, we analyzed the bone mineral density (BMD) in relation to the cumulative dose of CGT in patients who had undergone LT.


METHODS
We retrospectively collected information on 57 patients who underwent LT more than 1 year ago, which included demographics, cumulative CGT dose, BMD and t-scores of the femur/lumbar vertebra as measured by dual-energy X-ray absorptiometry (DEXA) for 1 and 2 years post-transplant. Patients receiving CGT >3500 mg/1st year were compared with CGT <3500 mg the first year. The group consisted of 75% males and 25% females.


RESULTS
Data showed that all patients on CGT had a moderately increased risk of fracture one year post-transplant. In the high dose group, females had significantly worse femur BMD and t-scores that persisted through the second year. This difference was not seen in the low dose group.


CONCLUSIONS
We found that all liver transplant patients on CGT have an increased risk of bone disease and that female patients receiving CGT >3500 mg the first year have a much higher risk of bone disease than males and that this risk persists during the second year. Because most of the steroids are given during the 1st month post-transplant, the amount of steroids given in this time period dictates the patients' risk for the subsequent 2 years.
Shah
Sheetal H
SH
Department of Surgery, University of Kentucky, Lexington, Kentucky, USA.
Johnston
Thomas D
TD
Jeon
Hoonbae
H
Ranjan
Dinesh
D
D015502:Absorptiometry, Photon; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005269:Femur / Q000737:chemistry; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D007629:Kentucky; D016031:Liver Transplantation / Q000502:physiology*; D008159:Lumbar Vertebrae / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors
D005938:Glucocorticoids