Bone loss after liver transplantation

McDonald, Jenny; Dunstan, Colin R.; Dilworth, Pamela; Sherbon, K. J.; Sheil, A. G. R.; Evans, Richard A.; McCaughan, Geoffrey W.

doi:10.1002/hep.1840140407

Cited by 176 publications

(117 citation statements)

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“…[15][16][17] There is recovery of bone mass after that time, but few studies reported long-term follow-up of these patients. 20,21 The median BMD of 20 patients with PBC actually increased to pre-OLT levels by 12 months in one study, 25 and improvement in BMD in patients with PBC for at least 5 years has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…This loss is maximal during the first 3 months and is also associated with a frequent incidence of spontaneous fractures. [15][16][17][18][19] The mechanisms of this bone loss are poorly understood but are likely related to immobilization, as well as high-dose corticosteroid therapy. There have been reports of bone mass recovery to pretransplantation levels, 20 but data on long-term follow-up in such patients are limited.…”

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Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

et al. 1999

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Patients with end-stage liver disease have low bone-turnover osteoporosis, and there is often further bone loss of 20% to 30% after orthotopic liver transplantation (OLT). Bone recovery after OLT has been reported, but data are limited. We undertook studies to determine whether bone recovery continues in the long term. Twenty-eight adult patients alive at least 5 years after OLT were studied (14 men, 14 women). Bone mineral density (BMD), serum parathyroid hormone (PTH), osteocalcin, and vitamin D levels were measured pretransplantation, at 3 months, 12 months, a mean of 46 months, and a mean of 85 months (range, 63 to 117 months) after transplantation. When BMD is expressed as a z score, the results were as follows: ؋0.82 ؎ 0.22 pre-OLT; ؊2.04 ؎ 0.27 at 3 months; ؊1.68 ؎ 0.24 at 12 months; ؊1.23 ؎ 0.24 at a mean of 46 months; and ؊1.0 ؎ 0.26 at a mean of 85 months after OLT. The results at 46 and 85 months were significantly greater than the measurement at 3 months after OLT (P F .05). Furthermore, mean BMD (expressed as a z score) returns to the pre-OLT level at a mean of 85 months. At final follow-up, 9 of 28 patients had elevated PTH levels, and 14 of 27 patients had elevated osteocalcin levels. Five patients had spontaneous fractures in the first 12 months after transplantation, and 5 more patients had fractures by final follow-up. Even at 7 years after OLT, there was a significant increase in BMD (expressed as a z score) compared with 3 months after transplantation. Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling.

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Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

et al. 1999

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“…In the first 6 months after OLT, bone mineral density (BMD) significantly declines, and this decline often is accelerated by immunosuppressive medications, corticosteroids, and immobility. [3][4][5][6] After 6 months, BMD increases rapidly and, by 12 months, approaches pre-OLT values. 6 However, some patients continue to lose BMD greater than 24 months after OLT and are at risk for osteoporotic fractures.…”

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The safety and outcome of joint replacement surgery in liver transplant recipients

Levitsky

2003

Liver Transplantation

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A small group of patients may require total hip arthroplasty, total knee arthroplasty, or other joint replacement surgery after OLT for osteoporotic fractures, osteonecrosis, and osteoarthritis. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The aim of the study was to determine the safety and outcome of joint replacement surgery in our liver transplant recipients. A retrospective analysis was performed on all liver transplant recipients who had total joint arthroplasty at a single teaching institution between 1986 and 2002. Data regarding major intraoperative and postoperative complications was obtained from the medical charts and a hospitalbased computer system. Of over 1,200 liver transplant recipients, we identified 7 patients who underwent 12 total arthroplasties (8 knee, 3 hip, 1 ankle). Joint replacements were performed electively for osteonecrosis (5 of 12) and osteoarthritis (5 of 12), whereas two hip arthroplasties were performed emergently for fractures. All patients with osteonecrosis or hip fracture had been treated with prolonged corticosteroids. There were no deaths or major complications in the intraoperative and postoperative periods. On long-term follow-up, no patients have had pain, dislocation, or infection in the postsurgical joint. No joint revision surgery has been required. In conclusion, a small number of stable liver transplant recipients at our institution underwent joint replacement surgery without major short-term or longterm complications. Our study suggests that joint replacement surgery may be safely and successfully performed in this population, although larger, randomized, prospective trials are needed to confirm our findings. (Liver Transpl 2003;9:373-376.)

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“…2 Rapid loss of vertebral mineral density has also been reported after renal transplantation, with most of the loss occurring within the first 6 months. 3 In the study by McDonald et al 4 spinal bone mineral density (BMD) decreased by 24% in the first 3 months after liver transplantation with no further decrease thereCorrespondence: M Kauppila, Turku University Central Hospital, Department of Medicine, Kiinamyllynkatu 4-8, 20520 Turku, Finland Received 12 October 1998; accepted 20 May 1999 after. Bone loss was related to number of hospital days but not to any other factor.…”

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Bone mineral density after allogeneic bone marrow transplantation

Kauppila

Irjala²,

Koskinen³

et al. 1999

Bone Marrow Transplant

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Summary:Bone turnover markers and bone mineral density (BMD) were studied in 25 adult patients (14 females, 11 males) who had undergone allogeneic bone marrow transplantation (BMT). The interval from BMT to the first examination was at least 1 year (mean 3, range 1-10). Mean age of the patients at the time of first evaluation was 42 (range 19-54) years. Blood samples and urine collections for evaluation of biochemical factors reflecting skeletal turnover were performed together with the first BMD measurement. BMD was measured from the lumbar vertebrae (L2 to L4) with computed tomography and results were expressed as Z-scores. At the time of the first measurement five patients (20%) had Z-scores Ͻ−2.5 s.d. and 12 patients (48%) between −1 and −2.5 s.d. In 12 patients BMD assessments were repeated and it seemed that reduction in BMD had mostly occurred during and shortly after BMT and remained the same during follow-up. The cross-linked carboxyterminal telopeptide of type I collagen (ICTP) correlated negatively with BMD (r = −0.45, P = 0.045) as did bone-specific alkaline phosphatase (BAP; r = −0.64, P = 0.002). No correlation between BMD and time interval from diagnosis to BMT, conditioning regimen, corticosteroid use or hospital stay during transplantation was found. In conclusion, bone disease is common after BMT. Our findings demonstrate an increased collagen and bone turnover and a high risk of osteoporosis. BMD measurements must be repeated regularly and collagen markers such as ICTP and BAP can be beneficial in estimating the activity of bone disease. Keywords: allogeneic bone marrow transplantation; ICTP; bone-specific alkaline phosphatase; bone mineral density; osteoporosis Transplant recipients are at risk of osteoporosis. Muchmore et al 1 reported low mean density of vertebral bone in heart transplant patients. Bone loss takes place mostly during the initial year after transplantation. 2 Rapid loss of vertebral mineral density has also been reported after renal transplantation, with most of the loss occurring within the first 6 months. after. Bone loss was related to number of hospital days but not to any other factor.Patients after allogeneic BMT are also exposed to numerous factors that can affect bone mineral metabolism: induction and consolidation therapies, bed rest, 5,6 conditioning regimen for BMT, steroids, 7 CsA therapy 8,9 and GVHD. 10 In female patients disturbance of gonadal function causes chronic estrogen deficiency 11 with an increased risk for osteoporosis. Carlson et al 12 studied the effect of myeloablative therapy on bone metabolism during the first 3 months after transplantation and found significant changes in serum markers of bone metabolism, which implied a net loss of bone over the study period. In 1997 Keilholz et al 13 reported normal BMDs after ABMT with a median interval of 5 years from autografting.The purpose of the present study was to evaluate the occurrence of bone disease after BMT by measuring BMD and biochemical markers of bone metabolism. Patients and methodsWe exami...

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Bone loss after liver transplantation

Abstract: The 35 patients we studied were 42 i 12 (S.D.) yr of age (range = 17 to 62 yr) and 14 were men. The 21 studied 3 mo

Cited by 176 publications

References 44 publications

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

The safety and outcome of joint replacement surgery in liver transplant recipients

Bone mineral density after allogeneic bone marrow transplantation

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