Original Article

Rheumatology International

, Volume 27, Issue 3, pp 251-256

Pamidronate and osteoporosis prevention in liver transplant recipients

  • Pietra PennisiAffiliated withService of Bone Diseases [WHO Collaborating Center for Osteoporosis Prevention], Department of Rehabilitation and Geriatrics, University Hospital of Geneva
  • , Andrea TrombettiAffiliated withService of Bone Diseases [WHO Collaborating Center for Osteoporosis Prevention], Department of Rehabilitation and Geriatrics, University Hospital of Geneva
  • , Emiliano GiostraAffiliated withService of Transplantation, Department of Surgery, University Hospital of Geneva
  • , Gilles MenthaAffiliated withService of Transplantation, Department of Surgery, University Hospital of Geneva
  • , René RizzoliAffiliated withService of Bone Diseases [WHO Collaborating Center for Osteoporosis Prevention], Department of Rehabilitation and Geriatrics, University Hospital of Geneva
  • , Carmelo E. FioreAffiliated withClinica Medica OVE, University of Catania Email author 

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Abstract

Osteoporosis is a common complication in patients with end-stage liver disease and after orthotopic liver transplantation (LT), with resulting increasing fracture rate. In this study, we investigated the role of treatment with pamidronate in preventing further bone loss after LT. Eighty-five patients with end-stage liver disease were included in the study. Pamidronate 30 mg was given intravenously every 3 months after LT for the duration of 1 year to 43 patients with osteopenia or osteoporosis prior LT. The remainders served as controls. All patients received a supplementation of calcium and vitamin D. Bone mineral density (BMD) at the lumbar spine and the femoral neck, and markers of bone metabolism were measured before and 12 months after LT. Sixty-two BMD were available at 12 months; only paired BMD were evaluated. A significant increase in lumbar spine BMD was observed in pamidronate treated patients. No change was evident in controls. Femoral neck BMD decreased in both treated and untreated patients. Osteocalcin serum levels and deoxypyridinoline urinary excretion were significantly reduced by treatment. Our study suggests that pamidronate decreases bone turnover and is effective in preventing the course of bone loss after LT, however the efficacy, at the dosage regimen employed and in a follow-up of 12 months, appears to be limited to trabecular bone, with no effect on the cortical structure of the femur.

Keywords

Liver transplantation Bone mineral density Cortical bone loss Bone turnover Pamidronate