Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation
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- Giannini, S., Nobile, M., Ciuffreda, M. et al. Osteoporos Int (2000) 11: 417. doi:10.1007/s001980070109
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We determined bone density and metabolism in 46 patients (35 males, 11 females) who had undergone liver transplantation 1–48 months previously. Twenty-one patients were then followed for the next 24 months. At each visit, blood and urine samples for bone and liver metabolism parameters, as well as spinal and femoral dual-energy X-ray absorptiometry (DXA) scans, were obtained. Basal spinal and femoral density was low (p<0.001). Patients with pre-transplant cholestatic diseases had lower spinal density than all the other subjects (p<0.05) and the cumulative methylprednisolone intake was an independent negative predictor of total hip density (p<0.02). At baseline, urinary hydroxyproline and N-telopeptide were at the upper normal level and decreased only after 24 months of follow-up (p<0.05). During the first year of follow-up, femoral density decreased (p<0.05) and a partial recovery was observed for both spine and femur after 24 months. After 12 months, femoral bone density was negatively associated with serum cyclosporin A levels (p<0.005) and cumulative methylprednisolone intake (p<0.05), while the percent decrease in spinal density after the first 12 months was negatively predicted by mean daily methylprednisolone intake (p<0.05). In patients with pre-transplant cholestatic diseases, femoral and spinal density increased after the first (p<0.05) and second year (p<0.05), respectively. In patients with previous post-necrotic cirrhosis, femoral density decreased after 12 months (p<0.05) and was still lower than baseline after 24 months (p<0.05). However, at the end of the study the cumulative percentage of femoral neck osteoporosis was 43%. In conclusion, an elevated prevalence of spinal and femoral osteoporosis is present even many years after liver transplantation, with immunosuppressive treatment and pre-transplant liver disease being the most important pathogenetic factors.