title: Skeletal integrity and visceral transplantation.
abstract: Despite continuous improvement in long-term survival, there is no knowledge about risk of bone health impairment and management strategies before and after intestinal transplantation. Therefore, 147 adults were retrospectively studied via chart review; 70 long-term survivors, 53 candidates and 24 recipients with longitudinal follow-up. Evaluation process included measurement of bone mineral density (BMD) and allied biochemical markers. Both long-term survivors and candidates showed low bone mass with lower (p < 0.05) z-scores at hip, femoral neck and spine. Vitamin D deficiency and secondary hyperparathyroidism were observed in both groups. Prevalence of osteoporosis was 44% among long-term survivors and 36% in candidates with age, BMD, duration of parenteral nutrition, type of immunosuppression and rejection being significant risk factors. Fragility fractures occurred at a higher (p = 0.02) rate among long-term survivors (20%) compared to candidates (6%). The longitudinal study documented acceleration (p = 0.025) of bone loss after transplantation with a decline of 13.4% (femoral neck), 12.7% (hip) and 2.1% (spine). Alendronate reduced (p < 0.05) but did not prevent bone loss. In conclusion, intestinal transplant recipients are at risk of osteoporosis secondary to bone loss before and after transplantation. Accordingly, current management includes comprehensive preventive measures with prompt therapeutic intervention utilizing intravenous bisphosphonates or subcutaneous human PTH.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Resnick
authors.forename: N
authors.initials: N
authors.lastname: Gupta
authors.forename: J
authors.initials: J
authors.lastname: Wagner
authors.forename: G
authors.initials: G
authors.lastname: Costa
authors.forename: R J
authors.initials: RJ
authors.lastname: Cruz
authors.forename: L
authors.initials: L
authors.lastname: Martin
authors.forename: D A
authors.initials: DA
authors.lastname: Koritsky
authors.forename: S
authors.initials: S
authors.lastname: Perera
authors.forename: L
authors.initials: L
authors.lastname: Matarese
authors.forename: K
authors.initials: K
authors.lastname: Eid
authors.forename: B
authors.initials: B
authors.lastname: Schuster
authors.forename: M
authors.initials: M
authors.lastname: Roberts
authors.forename: S
authors.initials: S
authors.lastname: Greenspan
authors.forename: K
authors.initials: K
authors.lastname: Abu-Elmagd
mesh_terms: D000328:Adult; D019386:Alendronate / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D015519:Bone Density; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D006962:Hyperparathyroidism, Secondary; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D015415:Biomarkers; D019386:Alendronate
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