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Secondary osteoporosis in liver transplant recipients: a longitudinal study in patients with and without cholestatic liver disease.

Abstract

BACKGROUND

Metabolic bone disease is one of the major long-term complications in liver transplant recipients, but it remains unclear which patients are at highest risk for developing severe bone disease following transplantation.

METHODS

A total of 46 consecutive, adult patients with chronic liver disease accepted for a liver transplantation waiting list were prospectively included in the study. The patients were classified into two groups: group A--chronic cholestatic liver disease (n = 28), and group B--chronic non-cholestatic liver disease (n = 18). Bone mineral density (BMD) was measured at acceptance for the waiting list and at 3, 12 and 36 months following transplantation. Markers of bone turnover (serum-bone specific alkaline phosphatases (bALP), s-osteocalcin, s-1-collagen-C-terminal telopeptide (1-CTP) and urine N-terminal telopeptides u-Ntx) were measured at acceptance and at 3, 6, 12, 24 and 36 months following transplantation. BMD and markers of bone turnover were compared with similar values in a matched control group of 42 healthy individuals.

RESULTS

BMD decreased significantly during the early post-transplantation period (median bone loss femoral neck (FN) 3 months post-transplant 8.5%). BMD levels declined slightly from 3 to 12 months following transplantation and increased thereafter. The relative bone loss was greatest among group B patients (relative bone loss FN 3 months post-transplant: group A, 8% versus group B, 13%; P = 0.04). At 36 months, 8/17 group A and 2/9 group B patients had BMD levels that exceeded the pretransplant levels (P = 0.12). The early bone loss was positively correlated with an increase in resorption markers (s-1-CTP and u-Ntx). Group B had higher levels of both s-1-CTP and u-Ntx at 3 and 6 months post-transplant than group A patients (P = 0.03). Bone formation markers increased slowly from 6 months post-transplant and onwards. Relative bone loss was positively correlated to total glucocorticoid dose during the first 3 months post-transplant. There were no differences in BMD between patients receiving tacrolimus versus those receiving cyclosporin A.

CONCLUSION

Bone loss following liver transplantation is considerable in patients with both cholestatic and non-cholestatic liver disease, the first group has the poorest starting-point while the latter group has the greatest bone loss following transplantation. Bone loss is closely correlated with biochemical markers of bone resorption and total dose of glucocorticoids given post-transplant.

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  • Authors+Show Affiliations

    ,

    Section of Hepatology and Gastroenterology, Dept. of Medicine, Rikshospitalet, NO-0027 Oslo, Norway. kristian.bjoro@labmed.uio.no

    , , , , ,

    Source

    MeSH

    Adult
    Aged
    Alkaline Phosphatase
    Biological Markers
    Bone Density
    Bone Resorption
    Cholestasis
    Collagen
    Collagen Type I
    Cyclosporine
    Female
    Femur Neck
    Follow-Up Studies
    Forearm
    Fractures, Bone
    Glucocorticoids
    Humans
    Immunosuppressive Agents
    Liver Diseases
    Liver Transplantation
    Longitudinal Studies
    Lumbar Vertebrae
    Male
    Middle Aged
    Norway
    Osteocalcin
    Osteoporosis
    Peptide Fragments
    Peptides
    Postoperative Complications
    Survival Analysis
    Tacrolimus
    Treatment Outcome
    Waiting Lists

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    12737449

    Citation

    TY - JOUR T1 - Secondary osteoporosis in liver transplant recipients: a longitudinal study in patients with and without cholestatic liver disease. AU - Bjøro,K, AU - Brandsaeter,B, AU - Wiencke,K, AU - Bjøro,T, AU - Godang,K, AU - Bollerslev,J, AU - Schrumpf,E, PY - 2003/5/10/pubmed PY - 2003/10/29/medline PY - 2003/5/10/entrez SP - 320 EP - 7 JF - Scandinavian journal of gastroenterology JO - Scand. J. Gastroenterol. VL - 38 IS - 3 N2 - BACKGROUND: Metabolic bone disease is one of the major long-term complications in liver transplant recipients, but it remains unclear which patients are at highest risk for developing severe bone disease following transplantation. METHODS: A total of 46 consecutive, adult patients with chronic liver disease accepted for a liver transplantation waiting list were prospectively included in the study. The patients were classified into two groups: group A--chronic cholestatic liver disease (n = 28), and group B--chronic non-cholestatic liver disease (n = 18). Bone mineral density (BMD) was measured at acceptance for the waiting list and at 3, 12 and 36 months following transplantation. Markers of bone turnover (serum-bone specific alkaline phosphatases (bALP), s-osteocalcin, s-1-collagen-C-terminal telopeptide (1-CTP) and urine N-terminal telopeptides u-Ntx) were measured at acceptance and at 3, 6, 12, 24 and 36 months following transplantation. BMD and markers of bone turnover were compared with similar values in a matched control group of 42 healthy individuals. RESULTS: BMD decreased significantly during the early post-transplantation period (median bone loss femoral neck (FN) 3 months post-transplant 8.5%). BMD levels declined slightly from 3 to 12 months following transplantation and increased thereafter. The relative bone loss was greatest among group B patients (relative bone loss FN 3 months post-transplant: group A, 8% versus group B, 13%; P = 0.04). At 36 months, 8/17 group A and 2/9 group B patients had BMD levels that exceeded the pretransplant levels (P = 0.12). The early bone loss was positively correlated with an increase in resorption markers (s-1-CTP and u-Ntx). Group B had higher levels of both s-1-CTP and u-Ntx at 3 and 6 months post-transplant than group A patients (P = 0.03). Bone formation markers increased slowly from 6 months post-transplant and onwards. Relative bone loss was positively correlated to total glucocorticoid dose during the first 3 months post-transplant. There were no differences in BMD between patients receiving tacrolimus versus those receiving cyclosporin A. CONCLUSION: Bone loss following liver transplantation is considerable in patients with both cholestatic and non-cholestatic liver disease, the first group has the poorest starting-point while the latter group has the greatest bone loss following transplantation. Bone loss is closely correlated with biochemical markers of bone resorption and total dose of glucocorticoids given post-transplant. SN - 0036-5521 UR - https://www.unboundmedicine.com/medline/citation/12737449/Secondary_osteoporosis_in_liver_transplant_recipients:_a_longitudinal_study_in_patients_with_and_without_cholestatic_liver_disease_ L2 - http://openurl.ebscohost.com/linksvc/linking.aspx?genre=article&sid=PubMed&issn=0036-5521&title=Scand J Gastroenterol&volume=38&issue=3&spage=320&atitle=Secondary osteoporosis in liver transplant recipients: a longitudinal study in patients with and without cholestatic liver disease.&aulast=Bjøro&date=2003 ER -