Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

Abstract

Patients with end-stage liver disease have low bone-turnover osteoporosis, and there is often further bone loss of 20% to 30% after orthotopic liver transplantation (OLT). Bone recovery after OLT has been reported, but data are limited. We undertook studies to determine whether bone recovery continues in the long term. Twenty-eight adult patients alive at least 5 years after OLT were studied (14 men, 14 women). Bone mineral density (BMD), serum parathyroid hormone (PTH), osteocalcin, and vitamin D levels were measured pretransplantation, at 3 months, 12 months, a mean of 46 months, and a mean of 85 months (range, 63 to 117 months) after transplantation. When BMD is expressed as a z score, the results were as follows: ؋0.82 ؎ 0.22 pre-OLT; ؊2.04 ؎ 0.27 at 3 months; ؊1.68 ؎ 0.24 at 12 months; ؊1.23 ؎ 0.24 at a mean of 46 months; and ؊1.0 ؎ 0.26 at a mean of 85 months after OLT. The results at 46 and 85 months were significantly greater than the measurement at 3 months after OLT (P F .05). Furthermore, mean BMD (expressed as a z score) returns to the pre-OLT level at a mean of 85 months. At final follow-up, 9 of 28 patients had elevated PTH levels, and 14 of 27 patients had elevated osteocalcin levels. Five patients had spontaneous fractures in the first 12 months after transplantation, and 5 more patients had fractures by final follow-up. Even at 7 years after OLT, there was a significant increase in BMD (expressed as a z score) compared with 3 months after transplantation. Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling.

Osteoporosis after liver transplantation

“…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.…”

“…In a smaller study of 28 patients, spine bone mineral density had returned to pre-transplantation levels by a mean of 85 months. 27 However, Monegal et al 15 reported recovery of bone mineral density in the spine but not the proximal femur by 36 months after transplantation and Hamburg et al 14 found that recovery of bone mineral density was often incomplete up to 15 years post-transplantation.…”

“…An increase in free testosterone following transplantation has been a common finding in these studies, although recovery to normal levels is not achieved in all patients. 15,27,33 …”

Posttransplantation care: Role of the primary care physician versus transplant center

“…51 Interestingly, bone recovery continues for up to 2 to 7 years after transplantation. [52][53][54] Crosbie et al 55 reported that accelerated bone loss in the transplant setting is caused by more bone resorption exceeding bone formation. Furthermore, calculation of an uncoupling index (osteocalcin-deoxypyridinoline) correlated well with bone mineral density and may serve as a noninvasive means to identify high-risk individuals.…”

Osteoporose após transplante de órgãos sólidos

“…verificaram recuperação da densidade mineral óssea após 7 anos de acompanhamento, ultrapassando os valores pré-transplante (49). Em um estudo menor, envolvendo 28 pacientes, a DMO retornou aos níveis pré-transplante em 85 meses (50). Entretanto, Hamberg SM e cols.…”