Bone disease following solid organ transplantation: A narrative review and recommendations for management from The European Calcified Tissue Society

Anastasilakis, Athanasios D.; Tsourdi, Elena; Makras, Polyzois; Polyzos, Stergios A.; Meier, Christian; McCloskey, Eugène; Pepe, Jessica; Zillikens, M. Carola

doi:10.1016/j.bone.2019.07.006

Cited by 43 publications

(52 citation statements)

References 211 publications

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“…The causes of bone loss and fragility fractures in transplant patients are numerous. In fact, many risk factors, such as age, female gender, malnutrition, low BMI, past history of fractures, and use of immunosuppressant drugs, including glucocorticoids, lead to increased bone fragility in lung and heart transplant patients [ 3 , 11 , 14 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study

Caffarelli

Pitinca

Alessandri

et al. 2020

JCM

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Bone loss and bone fractures are common complications after organ transplantation. Many factors contribute to the pathogenesis of transplant osteoporosis, such as bone disease preceding transplantation, immunosuppressive medications, and nutritional and lifestyle factors. This study aimed to assess the incidence of vertebral fractures before and after lung and heart transplantation. This longitudinal study analyzed 213 electronic medical records of patients who underwent lung transplantation (n = 128) and heart transplantation (n = 85) at Siena University Medical Center between January 2000 and December 2018. In lung and heart transplant recipients, the bone mineral density in the femoral sub-regions show a significant decrease at post-transplantation and at follow up visits. In both lung and heart recipients, we found an increase in the fracture incidence in the first period after transplantation (19.5% vs. 50.4% in lung recipients; 9.6% vs. 25.7% in heart recipients). Moreover, in lung recipients, vertebral fractures were predicted primarily by age, BMD at the femur, and any history of fracture. In heart recipients, vertebral fractures were predicted only by history of fracture. Our study supports the recommendations for pre-transplant osteoporosis screening in patients undergoing lung transplants, and in the first period after transplantation in heart transplant recipients.

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Section: Discussionmentioning

confidence: 99%

Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study

Caffarelli

Pitinca

Alessandri

et al. 2020

JCM

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“…The problem is more critical in transplant recipients since bone loss is accelerated during the period immediately after LT, leading to a greater incidence of fractures [18,134]. Post-transplantation worsening of bone disease are seen frequently in patients with pre-transplantation bone disease [35,42,135,136,137,138]. Osteoporosis is a serious complication that occurs after LT, with post-operative fractures observed in up to 35% of patients [11,136,137].…”

Section: Special Clinical Considerationsmentioning

confidence: 99%

“…Post-transplantation worsening of bone disease are seen frequently in patients with pre-transplantation bone disease [35,42,135,136,137,138]. Osteoporosis is a serious complication that occurs after LT, with post-operative fractures observed in up to 35% of patients [11,136,137]. Although its pathogenesis is multi-factorial, preexisting bone disease is a major risk factor in patients with chronic liver disease [2,136,138,139] and post-transplant medication may be another factor [136].…”

Section: Special Clinical Considerationsmentioning

confidence: 99%

“…Osteoporosis is a serious complication that occurs after LT, with post-operative fractures observed in up to 35% of patients [11,136,137]. Although its pathogenesis is multi-factorial, preexisting bone disease is a major risk factor in patients with chronic liver disease [2,136,138,139] and post-transplant medication may be another factor [136]. In addition, sudden activation of bone remodeling may induce the progression of bone diseases [140,141,142,143].…”

Section: Special Clinical Considerationsmentioning

confidence: 99%

“…In a study comparing bone histology before and after LT, this phase of bone turnover exerted a positive effect on bone turnover [142,143]. Factors involved in bone turnover in this second phase after LT are the normalization of liver function and the gradual reduction in glucocorticoids doses, which decrease bone resorption, as well as a secondary hyperparathyroidism related to cyclosporine and tacrolimus administration [18,136].…”

Section: Special Clinical Considerationsmentioning

confidence: 99%

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Bone Diseases in Patients with Chronic Liver Disease

Jeong

Kim

2019

IJMS

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Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.

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