Bone Mineral Density and Bone Turnover Markers Under Bisphosphonate Therapy Used in the First Year After Liver Transplantation.
BACKGROUND Rapid bone loss occurs early after liver transplantation (Tx), concomitantly with intensified bone turnover. In the present study we investigated the effect of bisphosphonates (bisph) added to vitamin D (vitD) and calcium on bone mineral density (BMD) and bone biomarkers in liver graft recipients in the first posttransplant year. MATERIAL AND METHODS In 28 patients BMD was determined at the third month after Tx. In case of osteopenia (Tscore ≤-1.0) and no contraindications, oral bisph was started for 1 year (group BP, n=14); other patients served as controls (CON, n=14). The changes in BMD and biomarkers of bone formation were osteocalcin (OC), bone alkaline phosphatase (BAP), and resorption. Study endpoints were active isoform 5b of the tartrate-resistant acid phosphatase (TRACP5b), serum pyridinoline crosslinks (PYD), and urine excretion of deoxypyridinoline (Dpd) crosslinks. RESULTS In 19 (68%) patients, reduced BMD (T-score ≤1.0) was observed at baseline. The changes in lumbar BMD in BP and CON groups were 5.2% and 1.5%, respectively, not reaching statistical significance. Baseline PYD, Dpd/creat, and OC were elevated in all patients, indicating high bone turnover. We observed decrease in PYD and Dpd/creat in both groups; however, OC decreased only under bisph therapy. Increase in BAP was observed in the control group but not in the BP group. The changes in BAP and OC were significantly different (p<0.01). CONCLUSIONS Combining bisph with vitD and calcium is an effective bone- sparing strategy in liver transplant recipients in the first posttransplant year. Bisph more efficiently decreased the rate of bone turnover than vitD and calcium alone.
Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Ewa
E
Nowacka-Cieciura
Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Anna
A
Sadowska
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
Marek
M
Pacholczyk
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
Andrzej
A
Chmura
Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Olga
O
Tronina
Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Magdalena
M
Durlik
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000097:blood / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D016723:Bone Remodeling / Q000187:drug effects; D016022:Case-Control Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D000071681:Tartrate-Resistant Acid Phosphatase / Q000097:blood
D000596:Amino Acids; D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D015675:Osteocalcin; C015484:pyridinoline; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase; C000605510:ACP5 protein, human; D000071681:Tartrate-Resistant Acid Phosphatase