title: Longitudinal changes in BMD and fracture risk in orthotopic liver transplant recipients not using bone-modifying treatment.
abstract: Osteoporosis is prevalent in end-stage liver disease, but data on long-term changes in bone mineral density (BMD) and related fracture incidence after orthotopic liver transplantation (OLT) are scarce. We evaluated BMD changes up to 5 years in consecutive recipients of a successful OLT at the Leiden University Medical Centre between 2000 and 2011, in whom sequential BMD data were available. Spinal radiographs were available at time of screening and at 6 and 12 months post-OLT and were assessed for vertebral fractures by two independent observers using Genant's semiquantitative method. Patients were excluded from the study when started on bisphosphonates. A total of 201 patients (71% men), median age 53 years (range, 18-70 years) were included in the study. Most common liver pathology was viral (27%) or alcoholic liver disease (25%). All patients received prednisone for at least 6 months after transplantation and the majority received either tacrolimus or cyclosporine for immunosuppression. At time of screening for OLT, osteoporosis and osteopenia were found in 18% and 36% of patients at the lumbar spine (LS), respectively, and in 9% and 42% at the femoral neck (FN), respectively. T-scores declined significantly at both sites 6 months after OLT, but increased thereafter at the LS, reaching pretransplantation values at 2 years and remaining stable thereafter. FN T-scores remained consistently lower than pretransplantation values. The prevalence of vertebral fractures increased from 56% at screening to 71% at 1 year after OLT, with a fracture incidence of 34%. BMD changes did not predict fracture risk. Osteoporosis, osteopenia, and vertebral fractures are prevalent in patients with end-stage liver disease. An overall decline in BMD is observed within the first 6 months after OLT, with subsequent recovery to pretransplantation values at the LS, but not at the FN. Vertebral fracture risk is high after OLT regardless of changes in BMD.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Charlotte G
authors.initials: CG
authors.lastname: Krol
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: Herman M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.forename: Neveen At
authors.initials: NA
authors.lastname: Hamdy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D050071:Bone Density Conservation Agents / Q000494:pharmacology; D005260:Female; D049674:History, 21st Century; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000453:epidemiology*; D013131:Spine / Q000000981:diagnostic imaging
chemical_list: D050071:Bone Density Conservation Agents
keywords: DXA; EPIDEMIOLOGY; FRACTURE RISK; INCIDENCE OSTEOPOROSIS; OSTEOPOROSIS; VERTEBRAL FRACTURES