Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation
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.
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