A systematic review and meta‐analysis on the incidence of osteoporosis and fractures after liver transplant

Abstract

Following liver transplant (LT), osteoporosis is a severe complication that causes morbidity. However, the incidence and risk factors of osteoporosis and fractures have not been well described. Single-arm meta-analysis of studies reporting osteopenia, osteoporosis, and fractures post-LT was performed with meta-regression for study period. Dichotomous variables, continuous variables and time-to-event variables were pooled in odds ratio, weighted mean difference and hazard ratio, respectively. For risk factors with limited data, a systematic review of literature was conducted. There was a significant increase in both osteoporosis and fractures compared to non-LT patients. Osteopenia, osteoporosis and incident fractures were newly diagnosed in 34.53% (CI: 0.17-0.56, n = 301), 11.68% (CI: 0.05-0.24, n = 1251) and 20.40% (CI: 0.13-0.30, n = 4322) of LT patients, respectively. Female gender (P = 0.017) increased risks of osteoporosis but not older age and BMI. Older age, lower pre-LT bone mineral density (BMD), presence of bone disease pre-LT were significant risk factors for fractures but not female gender, post-menopausal state, BMI, smoking and alcohol. There is a high incidence of skeletal complications post-LT. Older age, lower pre-LT BMD and presence of bone disease pre-LT are significant risk factors that are associated with incident fractures physicians should be cognisant of in liver transplant recipients.

High risk of osteoporosis and fracture following solid organ transplantation: a population-based study

“…The reason for BMD reduction in the early posttransplant period may be due to the pre- and posttransplant changes in bone turnover state. A meta-analysis indicated that liver transplant recipients have a fivefold increased risk of both osteoporosis and fractures compared with non-LT recipients ( 37 ). The main risk factors for postliver transplant fractures include the presence of pretransplant fractures, decreased BMD, posttransplant glucocorticoid dose, and primary biliary cholangitis ( 38 ).…”

Navigating Post-Traumatic Osteoporosis: A Comprehensive Review of Epidemiology, Pathophysiology, Diagnosis, Treatment, and Future Directions

“…As individuals age, there is a progressive decrease in bone mineral density, primarily affecting trabecular bone due to its higher metabolic activity and turnover rate compared to cortical bone [96]. This age-related decline in BMD is influenced by factors such as hormonal changes, decreased physical activity, and impaired remodeling capacity due to decreased osteoblast-osteoclast function [97]. Therefore, one possibility of older individuals presenting for evaluation after trauma is unmasking previously subclinical osteoporosis.…”

Physical Exercise After Solid Organ Transplantation: A Cautionary Tale

“…Even patients without a pretransplant history of osteoporosis face an elevated risk of posttransplant osteoporosis and fractures [12,13]. The incidence of fractures is four to five times higher compared to the general population [14,15] and can be attributed, in part, to the side effects of immunosuppressive agents such as glucocorticoids, cyclosporine A, and tacrolimus [16][17][18][19]. Particularly in individuals engaging in endurance sports, an imbalance between energy expenditure and caloric intake can lead to the relative energy deficiency in sport syndrome, further reducing bone mineral density and increasing the risk for stress fractures [20,21].…”