Osteoporosis in Chronic Liver Disease: Pathogenesis, Risk Factors, and Management

McCaughan, Geoffrey W.; Feller, R.

doi:10.1159/000171456

Cited by 63 publications

(31 citation statements)

References 33 publications

(56 reference statements)

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“…10,13,23,24 After OLT, there is NOTE. Abnormal graft function is defined as at least two liver enzymes Ն1.5ϫ the upper limit of normal.…”

Section: Discussionmentioning

confidence: 99%

“…Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling. Copyright 1999 by the American Association for the Study of Liver Diseases B one disease is well recognized in patients with chronic liver disease [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and is usually caused by low bone-turnover osteoporosis. 5,8,9,12 Although orthotopic liver transplantation (OLT) may stabilize or reverse this process, there is further significant postoperative bone loss.…”

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confidence: 99%

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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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“…10,13,23,24 After OLT, there is NOTE. Abnormal graft function is defined as at least two liver enzymes Ն1.5ϫ the upper limit of normal.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 1999

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“…Rapid bone loss with a decrease in spinal bone mineral density (BMD) as high as 6.8 ± 5.6% at 6 months and 8.8 ± 7.0% 18 months after renal transplantation [12] is seen, especially in the first year after transplantation. Besides immobilization after transplantation and the use of immunosuppressive regimens, pre-existing osteoporosis and/or osteomalacia [21,22] are risk factors for occurrence of fractures.…”

Section: Introductionmentioning

confidence: 99%

Bone Loss in Long-Term Survivors after Transplantation of Hematopoietic Stem Cells: A Prospective Study

Schulte¹,

Beelen²,

Schaefer³

et al. 2000

Osteoporosis International

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Organ transplantation is associated with relevant bone loss. Bone loss of up to 20% of pretransplant bone mineral density (BMD) values within the first year after kidney, liver, heart and lung transplantation has been reported. Patients undergoing transplantation of hematopoietic stem cells provide an interesting model to study transplantation-induced bone loss, especially because most patients do not have preexisting bone disease. A longitudinal study was performed in 81 patients undergoing bone marrow or peripheral blood stem cell transplantation. BMD was determined by dual-energy X-ray absorptiometry before transplantation, at discharge from the hospital, and at 6 and 12 months after transplantation in all 81 patients. In 35 patients BMD was re-evaluated 24 months after transplantation. Vitamin D and parathyroid hormone, bone alkaline phosphatase as a marker of bone formation, and N-terminal telopeptide of type I collagen as a marker of bone resorption were assessed before transplantation and in the short-term follow-up 14 and 28 days after transplantation. The majority of patients (72%) showed normal BMD before transplantation. However, lower BMD was observed in patients who had received high-dose cytoreductive chemotherapy before transplantation compared with those who had received no chemotherapy or only hydroxyurea. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (1000 IU/day), the mean rate of bone loss during the first year was 7.2 +/- 6.3% at the lumbar spine, 11.9 +/- 8.1% at the femoral neck and 3.8 +/- 2.5% at the total body compartment. Evaluation of the pattern of bone loss during the first year demonstrated that the amount of bone loss was largest within the first 40 days after transplantation and small during the second half of the first year after transplantation. The majority of patients showed vitamin D deficiency and secondary hyperparathyroidism. Bone formation was normal before and after transplantation, whereas bone resorption was dramatically increased before and after transplantation. Exposure to glucocorticoids was associated with higher bone loss at spine and femoral neck but not at the total body compartment. Our data demonstrate rapid bone loss in patients undergoing transplantation of hematopoietic stem cells. Bone turnover is characterized by biochemical uncoupling of bone resorption and bone formation, changes interestingly pre-existing before transplantation. The observed alterations in bone mass and metabolism emphasize the importance of clinical trials with antiresorptive agents to prevent and treat post-transplantation osteoporosis in this group of patients.

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“…17 In our center, it is policy to strongly encourage smoking cessation in transplant candidates in light of the association with alcohol use as well as other negative health consequences. [18][19][20] Meta-analysis demonstrated that at long-term follow-up, participation in a smoking cessation intervention provided during substance abuse treatment was associated with long-term abstinence from alcohol and other drugs. 21 Consistent with these findings, data suggest that 1 year after treatment, smokers who participated in a substance abuse treatment program and initiated smoking cessation on their own were less likely to be diagnosed as alcohol dependent and had more days abstinent from alcohol and other substances than those who started or continued smoking during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

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2015

Exp Clin Transplant

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Osteoporosis in Chronic Liver Disease: Pathogenesis, Risk Factors, and Management

Cited by 63 publications

References 33 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

Bone Loss in Long-Term Survivors after Transplantation of Hematopoietic Stem Cells: A Prospective Study

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