Bone Mineral Status in End-Stage Liver Disease and the Effect of Liver Transplantation

Abdelhadi, Mohamed; Eriksson, S; Eriksson, Siv; Ericzon, Bo Göran; Nordenström, Jörgen

doi:10.3109/00365529509101633

Cited by 45 publications

(31 citation statements)

References 18 publications

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“…Immunosuppressive drugs certainly play a major role in this setting [10,11]. Although the alterations seen in bone metabolism after liver transplantation have been mainly attributed to the use of glucocorticoids [4][5][6]19], most authors failed to demonstrate this relationship. This is probably due to the fact that the majority of studies concentrated on an early phase after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation

Giannini

Nobile

Ciuffreda

et al. 2000

Osteoporosis International

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We determined bone density and metabolism in 46 patients (35 males, 11 females) who had undergone liver transplantation 1-48 months previously. Twenty-one patients were then followed for the next 24 months. At each visit, blood and urine samples for bone and liver metabolism parameters, as well as spinal and femoral dual-energy X-ray absorptiometry (DXA) scans, were obtained. Basal spinal and femoral density was low (p < 0.001). Patients with pre-transplant cholestatic diseases had lower spinal density than all the other subjects (p <0.05) and the cumulative methylprednisolone intake was an independent negative predictor of total hip density (p < 0.02). At baseline, urinary hydroxyproline and N-telopeptide were at the upper normal level and decreased only after 24 months of follow-up (p < 0.05). During the first year of follow-up, femoral density decreased (p < 0.05) and a partial recovery was observed for both spine and femur after 24 months. After 12 months, femoral bone density was negatively associated with serum cyclosporin A levels (p < 0.005) and cumulative methylprednisolone intake (p < 0.05), while the percent decrease in spinal density after the first 12 months was negatively predicted by mean daily methylprednisolone intake (p < 0.05). In patients with pre-transplant cholestatic diseases, femoral and spinal density increased after the first (p < 0.05) and second year (p < 0.05), respectively. In patients with previous post-necrotic cirrhosis, femoral density decreased after 12 months (p<0.05) and was still lower than baseline after 24 months (p < 0.05). However, at the end of the study the cumulative percentage of femoral neck osteoporosis was 43%. In conclusion, an elevated prevalence of spinal and femoral osteoporosis is present even many years after liver transplantation, with immunosuppressive treatment and pre-transplant liver disease being the most important pathogenetic factors.

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Section: Discussionmentioning

confidence: 99%

Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation

Giannini

Nobile

Ciuffreda

et al. 2000

Osteoporosis International

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“…Strongest was the association between hyponatremia and liver insufficiency, which is also known to negatively impact bone metabolism, seemingly irreversible despite liver transplantation for end-stage liver disease [27][28][29][30]. Several markers of protein synthesis, clotting factor production, and cholestasis were significantly altered in hyponatremic patients, i.e., elevated levels of ALAT, bilirubin count, cobalamin, GGT, and APTT, while albumin levels were significantly lower.…”

Section: Hyponatremia As a Marker Of Secondary Osteoporosismentioning

confidence: 96%

Hyponatremia and osteoporosis: insights from the Danish National Patient Registry

2014

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“…8 The mechanisms underlying this early increase have not been established but may be related to vitamin D deficiency, intestinal calcium malabsorption,or reduced renal tubular reabsorption of calcium. An increase in plasma parathyroid hormone levels has been more consistently noted after longer-term followup 15,20,22,23,27,33 and may be related to cyclosporin-induced renal dysfunction.…”

Section: Secondary Hyperparathyroidismmentioning

confidence: 99%

“…12,19 Low bone mineral density in patients awaiting liver transplantation has been reported in a number of studies 17,33,51,55,57 although this finding has not been universal. 20 In a study of 243 consecutive patients with chronic liver disease undergoing assessment for liver transplantation, Ninkovic et al reported that 36.6% had osteoporosis according to WHO criteria 58 (a T score below -2.5) and bone mineral density was normal (T score above -1) in only 15.2%. 57 Importantly, men and women were equally affected and with the exception of increasing age and lower body weight in women, no independent risk factors were identified, emphasising the importance of bone mineral density measurements in these patients.…”

Section: Pre-existing Bone Diseasementioning

confidence: 99%

“…7,8,15,17,[20][21][22][23][24][25] Bone loss affects the spine and the proximal femur, some studies suggesting greater bone loss at the latter site. 17,18,26 The majority of studies indicate that there is at least some recovery of bone mineral density after the first year or so of transplantation, although this finding has not been universal.…”

Section: Changes In Bone Mineral Density After Liver Transplantationmentioning

confidence: 99%

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Osteoporosis after liver transplantation

Compston

2003

Liver Transplantation

107

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L iver transplantation is now a well-established procedure with 5-year survival rates of over 70% in most centers. 1 The quality of life for the majority of survivors is good, but a number of long-term complications have been described, many of which are related to immunosuppressive therapy. The main skeletal complications are avascular necrosis and osteoporosis, of which the latter is most common and may result in significant morbidity and mortality.Studies performed early in the history of liver transplantation documented rapid bone loss and a high incidence of fragility fractures, but there is evidence that the frequency of osteoporosis after transplantation may be decreasing, providing important insights into its pathogenesis. This review considers the clinical features, pathogenesis, pathophysiology, and management of osteoporosis after liver transplantation and considers the lessons that may be learnt from changes in its natural history. Clinical FeaturesOsteoporosis is characterised by reduced bone mass and disruption of bone architecture, leading to decreased bone strength and an increase in the risk of fragility fracture particularly at the wrist, hip and spine. 2 These fractures are associated with a high morbidity and increased mortality and often have devastating effects on quality of life.

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Bone Mineral Status in End-Stage Liver Disease and the Effect of Liver Transplantation

Abstract: Early and accelerated bone loss occurred after liver transplantation. This bone reduction seems to be mainly the result of increased bone resorption, possibly related to corticosteroid therapy.

Cited by 45 publications

References 18 publications

Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation

Long-Term Persistence of Low Bone Density in Orthotopic Liver Transplantation

Hyponatremia and osteoporosis: insights from the Danish National Patient Registry

Osteoporosis after liver transplantation

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