Osteoporosis after liver transplantation

Abstract

L iver transplantation is now a well-established procedure with 5-year survival rates of over 70% in most centers. 1 The quality of life for the majority of survivors is good, but a number of long-term complications have been described, many of which are related to immunosuppressive therapy. The main skeletal complications are avascular necrosis and osteoporosis, of which the latter is most common and may result in significant morbidity and mortality.Studies performed early in the history of liver transplantation documented rapid bone loss and a high incidence of fragility fractures, but there is evidence that the frequency of osteoporosis after transplantation may be decreasing, providing important insights into its pathogenesis. This review considers the clinical features, pathogenesis, pathophysiology, and management of osteoporosis after liver transplantation and considers the lessons that may be learnt from changes in its natural history. Clinical FeaturesOsteoporosis is characterised by reduced bone mass and disruption of bone architecture, leading to decreased bone strength and an increase in the risk of fragility fracture particularly at the wrist, hip and spine. 2 These fractures are associated with a high morbidity and increased mortality and often have devastating effects on quality of life.

Post-Transplantation Osteoporosis

“…Bone loss and increased risk for fracture are common complications after liver transplantation (29). The progression of bone loss is similar to that following lung and cardiac transplantation, being more severe in the first 6-12 months.…”

Osteoporosis in Gastrointestinal Diseases

“…After liver transplantation, an osteoporotic bone is exposed to additional risks, even to the immunosuppressive therapy the patient has to take for life. The patients require calcium and vitamin D supplementation [19]. American Society of Gastroenterology recommends performing a DXA study in patients with chronic liver disease: after an osteoporotic bone fracture, in postmenopausal women, in patients chronically treated with glucocorticoids for more than 3 months, after a diagnosis of PBC and in patients with cirrhosis of the liver, prior to liver transplantation.…”

Biochemical Markers of Bone Resorption and Hormonal Regulation of Bone Metabolism Following Liver Transplantation

“…том XV № 1-2013 ВВЕДЕНИЕ Известно, что хронические заболевания печени ассоциируются с различными метаболическими за-болеваниями скелета, из которых наиболее распро-страненными являются остеопороз и остеопения, диагностируемые у 40-70% пациентов [10,11,21].…”