Osteoporosis International

, Volume 11, Issue 7, pp 600–606

Bone Mineral Density in the Long Term after Liver Transplantation


  • S. M. Hamburg
    • Department of Gastroenterology and Hepatology
  • D. A. Piers
    • Department of Nuclear Medicine,
  • A. P. van den Berg
    • Department of Gastroenterology and Hepatology
  • M. J. H. Slooff
    • Department of Surgery, University Hospital, Groningen, The Netherlands
  • E. B. Haagsma
    • Department of Gastroenterology and Hepatology
Original Article

DOI: 10.1007/s001980070081

Cite this article as:
Hamburg, S., Piers, D., van den Berg, A. et al. Osteoporos Int (2000) 11: 600. doi:10.1007/s001980070081


Hepatic osteodystrophy is a complication of chronic liver disease and bone mass is known to decline further in the first year after liver transplantation. The present study focused on bone mineral density (BMD) between 1 and 15 years after liver transplantation under a prednisolone- and azathioprine-based immunosuppressive regimen. Three groups of adult patients were studied: group 1, 45 patients with a follow-up of 5–9 years after transplantation, had BMD measurements done at 1, 2 and 5 years after transplantation; group 2, 17 patients with a follow-up of 10–14 years, had BMD measurements done at 5 and 10 years; group 3, 4 patients with a follow-up of more than 15 years, had BMD measurements done at 10 and 15 years. BMD of lumbar spine (L1–L4) and proximal femur was measured using dual-energy X-ray absorptiometry, and at the same time radiographs of the spine and hips were made. Spinal BMD increased significantly, during the second post-transplant year; subsequently no significant changes were seen. Proximal femur BMD decreased slightly, but significantly during the second year, and remained stable afterwards. About one-third of patients had a BMD below the fracture threshold (= 0.798 g/cm2 for the lumbar spine and 0.675 g/cm2 for the hip) during the follow-up. In 5 of the 66 patients studied, new vertebral fractures occurred. No fractures or avascular necrosis of the hips were seen. Furthermore, after transplantation lower Z-scores of the hip were found in patients with pre-transplant cholestatic liver diseases, and lower Z-scores of the lumbar spine were found in men compared with women. Long-term follow-up of BMD up to 15 years after transplantation revealed an improvement mainly in the second postoperative year with no deterioration afterwards. Nevertheless a substantial number of patients (around one-third) kept a BMD below the fracture threshold, and new fractures may occasionally occur. The overall outcome appeared somewhat less favorable in men and patients transplanted for cholestatic liver diseases.

Key words:Bone mineral density – Liver transplantation – Osteoporosis

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2000