title: Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels.
abstract: OBJECTIVE
  To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees.
  
  
  METHODS
  Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined.
  
  
  RESULTS
  Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33+/-2.32 mm (range 0.67-9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2+/-26.4). The mean 25(OH)D(3) was 11.68+/-4.7, range 3.5-21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D(3) levels > or =30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r =-0.474, p=0.03). A positive correlation was found between ABL, PTH (r =0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r =0.810, p=0.004).
  
  
  CONCLUSIONS
  The majority of liver transplant patients had insufficient 25(OH)D(3) serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.
authors.affiliation: Periodontal Unit, Department of Oral & Dental Medicine, Rambam Health Care Campus, Haifa, Israel. o_o-barak@rambam.health.gov.il
authors.forename: Orit
authors.initials: O
authors.lastname: Oettinger-Barak
authors.forename: Elena
authors.initials: E
authors.lastname: Segal
authors.forename: Eli E
authors.initials: EE
authors.lastname: Machtei
authors.forename: Shlomi
authors.initials: S
authors.lastname: Barak
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Baruch
authors.forename: Sofia
authors.initials: S
authors.lastname: Ish-Shalom
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016301:Alveolar Bone Loss / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000378:metabolism*; D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology; D015519:Bone Density / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000378:metabolism; D008439:Maxillary Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000378:metabolism; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011859:Radiography; D012044:Regression Analysis; D013256:Steroids / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D013256:Steroids