Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis

Abstract

Atraumatic fractures caused by osteoporosis may be a serious complication of primary biliary cirrhosis. Mean (+/- S.D.) bone mineral density in the lumbar spine in 210 ambulatory women with primary biliary cirrhosis was 1.02 +/- 0.19 gm/cm2, 7% lower than that in 139 age-matched normal women (after adjustment for age and body weight) (p less than 0.001). Bone mineral density in the lumbar spine was inversely related to a risk score index of liver disease severity (r = -0.29, p less than 0.001). The mean rate of bone loss in 105 of these 210 women was 2%/yr +/- 4%/yr, twice as great as in the 139 normal women (p less than 0.02). In 20 women with primary biliary cirrhosis followed up after orthotopic liver transplantation, bone mineral density in the lumbar spine decreased at 3 mo (p less than 0.01), and this decrease may have resulted in atraumatic fractures in 13 of them. Bone mineral density in the lumbar spine then increased (p less than 0.01) so that by 12 mo the median bone mineral density in the lumbar spine was similar to that before transplantation and by 24 mo it was 5% above it. Therefore we conclude that the progressive bone loss observed in primary biliary cirrhosis (which is further accentuated immediately after transplantation) may be halted, and the bone mass may be restored toward normal within 2 to 3 yr after orthotopic liver transplantation.

Patients with cirrhosis and ascites have false values of bone density

“…2. In addition, it has been reported that BMD measurements with dual photon absorptiometry, using 153 Gd as the source in patients with an abdominal diameter higher than 27 cm are unreliable [25]. Indeed, our study supports this observation, since a baseline abdominal diameter higher or lower than 27 cm was associated with different behavior in BMD results at the spine, reinforcing the fact that the volume of ascitic fluid is the main determinant of inaccuracies in BMD measurements at the central skeleton.…”

Bone Mineral Density in the Long Term after Liver Transplantation

“…More than 3 months after transplantation BMD remains stable or gradually increases [1± 4,6,8]. In studies with BMD measurements up to 2 years after transplantation, an improvement in spinal BMD in the second year in women transplanted for primary biliary cirrhosis was reported by Eastell et al [6], and an improvement in spinal BMD in patients transplanted for primary biliary cirrhosis and primary sclerosing cholangitis was reported by Porayko et al [2]. In the latter study, however, spinal BMD continued to decrease in patients with chronic active hepatitis and miscellaneous liver diseases prior to transplantation.…”

“…It is well known that bone mass decreases after liver transplantation, especially in the ®rst 3 months [1±4, 6,8], with an accompanying high fracture rate in the ®rst 6 months [1,2,4,9]. More than 3 months after transplantation BMD remains stable or gradually increases [1± 4,6,8].…”

Ursodeoxycholic Acid Enhances Fractional Calcium Absorption in Primary Biliary Cirrhosis

“…In conclusion, a better understanding of the pathophysiology of bone disease in PBC should have a profound impact on its prevention and treatment, considering that the rates of bone loss can be as high as twice that of the normal population [4]. A lowturnover form of osteoporosis, such as is commonly seen in PBC, is likely to be less responsive to established antiresorptive agents.…”

“…Early reports have described an association of PBC with osteomalacia [1,2]. It is now becoming increasingly clear that a majority of PBC patients have osteoporosis [2,3] with bone loss rates up to twice that of the normal population [4]. Histomorphometric studies indicate that bone remodeling is suppressed [5].…”