Serial measurements of bone density at the lumbar spine do not predict fracture risk after liver transplantation

Abstract

Bone disease has emerged as a serious and complex complication after liver transplantation. The purpose of this study is to determine risk factors for fracture and bone loss after liver transplantation. Dual-energy x-ray absorptiometry (DEXA) of the lumbar spine was performed routinely pretransplantation, 6 months posttransplantation, and at yearly intervals thereafter at our center. We followed up patients who underwent transplantation in the past 10 years and compared bone mineral density (BMD) and fracture rate with known risk factors for bone loss in primary transplant recipients who met the inclusion criteria of a pretransplantation DEXA and at least one follow-up DEXA scan postoperatively (n ‫؍‬ 153). We observed a 15% (n ‫؍‬ 23) prevalence of symptomatic fractures at a mean of 2.2 ؎ 1.8 years after transplantation. Change in BMD was greatest from pretransplantation to 6 months posttransplantation (؊4.2%; P ‫؍‬ .006), then increased at a rate of 1.4% per year. Logistic regression analysis showed an association of fracture risk with several factors, including number of acute rejection episodes (P ‫؍‬ .045), smoking (P ‫؍‬ .02), and female sex (P ‫؍‬ .02).Stepwise logistic regression analysis reported female sex (P ‫؍‬ .004) as the only factor associated with fracture after transplantation. Age, time listed for transplantation, race, menopause, chronic renal insufficiency, loss of height, family history of osteoporosis, BMD, and T score did not predict fracture or bone loss after transplantation. In conclusion, serial measurements of BMD at the lumbar spine do not appear to predict fracture risk; however, data suggest that female sex is the strongest predictor of fracture after liver transplantation. (Liver Transpl 2003;9: 857-862.)

Alendronate in combination with calcium and vitamin D prevents bone loss after orthotopic liver transplantation: A prospective single-center study

“…The fracture incidence, the final and most debilitating complication of osteopathy, was very low in our study with 5.8% (8 / 136 transplanted patients). Previous publications with large cohorts of LT recipients reported fracture rates between 7.5% and 65% 1, 48–50. In agreement with other studies, the majority of our patients who showed fractures developed vertebral compression fractures and traumatic fractures of peripheral bones.…”

Effect of bisphosphonates on bone mineral density in liver transplant patients: a meta-analysis and systematic review of randomized controlled trials

“…Bisphosphonates act by inhibiting the apoptosis of osteoclasts and osteoblasts and are the cornerstone of antiresorptive therapy in postmenopausal and steroid‐induced osteoporosis [19]. BMD measurements are widely accepted in clinical practice to guide therapy with bisphosphonates, although it has been shown that BMD values do not accurately predict fracture risk in individuals [20]. Likewise, the utility of BMD values in predicting fracture risk in organ transplant patients is still unclear.…”

Prophylactic Bisphosphonate Treatment Prevents Bone Fractures After Liver Transplantation

“…One investigator suggested that aledronate is efficacious in preventing the natural course of bone loss associated with LT (13). However, measurements of BMD at the lumbar spine do not accurately predict the risk of fractures after LT (14). So far, no randomized, controlled study on the effect of bisphosphonate therapy for preventing fractures in LT recipients after transplantation has been published.…”