Skeletal integrity and visceral transplantation.
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.
Resnick
J
J
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Gupta
N
N
Wagner
J
J
Costa
G
G
Cruz
R J
RJ
Martin
L
L
Koritsky
D A
DA
Perera
S
S
Matarese
L
L
Eid
K
K
Schuster
B
B
Roberts
M
M
Greenspan
S
S
Abu-Elmagd
K
K
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
D015415:Biomarkers; D019386:Alendronate
Transplant Proc. 2000 Sep;32(6):1223-4
10995920
JPEN J Parenter Enteral Nutr. 2004 Sep-Oct;28(5):289-94
15449566
Calcif Tissue Int. 2001 Dec;69(6):321-6
11800228
Osteoporos Int. 2008 Oct;19(10):1369-78
18633664
Ann Surg. 2009 Sep;250(3):395-402
19661785
Gut. 2008 May;57(5):684-94
18408105
J Bone Miner Res. 1994 Aug;9(8):1137-41
7976495
Ann Surg. 2001 Sep;234(3):404-16; discussion 416-7
11524593
Gastroenterology. 2003 Sep;125(3):941-66
12949738
Nutr Clin Pract. 2007 Jun;22(3):329-39
17507733
Transplantation. 1999 Jul 27;68(2):220-7
10440391
Am J Transplant. 2007 Jul;7(7):1763-9
17511759
J Am Soc Nephrol. 2003 Oct;14(10):2669-76
14514747
Transpl Int. 2009 Jan;22(1):96-109
18954362
Clin Liver Dis. 2005 Nov;9(4):747-66, viii
16207574
Ann Surg. 2009 Oct;250(4):567-81
19730240
Transplantation. 2003 Feb 15;75(3):330-4
12589153
Bone Marrow Transplant. 2009 Jul;44(1):35-41
19139732
Am J Clin Nutr. 1985 Mar;41(3):614-9
3919560
J Clin Invest. 1994 Feb;93(2):799-808
8113412
Curr Osteoporos Rep. 2009 Sep;7(3):91-5
19723467
Am J Clin Pathol. 2007 May;127(5):736-43
17439832
Am J Clin Nutr. 2009 Jan;89(1):204-9
19056562
J Clin Densitom. 1999 Fall;2(3):275-83
10548823
Osteoporos Int. 1994 Nov;4(6):368-81
7696835
Bone Marrow Transplant. 2006 Jan;37(1):81-8
16247420
Ann Surg. 2005 Apr;241(4):607-13
15798462
N Engl J Med. 2009 Aug 20;361(8):756-65
19671655
Trends Mol Med. 2008 Jun;14(6):245-53
18468489
J Hepatol. 2005 Apr;42(4):573-7
15763344
Osteoporos Int. 2000;11(4):344-53
10928225
J Bone Miner Res. 1999 Mar;14(3):342-50
10027899
Nature. 1998 Oct 22;395(6704):763-70
9796811
Am J Med. 1997 Sep;103(3):197-207
9316552
J Bone Miner Res. 2003 Nov;18(11):1989-94
14606511
Transpl Int. 2010 Feb;23(2):200-7
19793074
Transplant Proc. 1994 Jun;26(3):1684-5
8030087
JAMA. 2002 Dec 18;288(23):3014-8
12479766
Ann Intern Med. 2006 Feb 21;144(4):239-48
16490909
J Bone Miner Res. 2010 Jan;25(1):164-72
19821764
Nat Rev Gastroenterol Hepatol. 2009 Nov;6(11):660-70
19881518
Support Care Cancer. 2008 Aug;16(8):879-89
18392862
Osteoporos Int. 2004 Apr;15(4):263-73
14985946
Osteoporos Int. 2000;11(12):985-1009
11256898
J Clin Endocrinol Metab. 2009 May;94(5):1483-90
19420272
J Clin Endocrinol Metab. 2006 Oct;91(10):3835-43
16835281
Adv Surg. 2002;36:65-101
12465547
Transplant Proc. 2005 Apr;37(3):1471-2
15866643
Hepatology. 2002 Jan;35(1):126-31
11786968
Am J Med. 1996 Sep;101(3):262-9
8873487
J Clin Invest. 2002 Sep;110(6):771-81
12235108