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Abstract
Background
Bone loss after liver transplant (LT) is a long-term problem associated with an increased morbidity due to pathologic fractures. We reviewed our management of post-LT bone loss.
Methods
We collected retrospective data from 82 adult LT recipients between January 2006 and December 2009 who had preoperative and postoperative (12 to 24 months) bone mineral density (BMD) data measured by dual energy X-ray absorptiometry (DXA). BMD was decreased in 52 out of 82 patients before LT. These patients were managed with calcium plus alendronate, calcium only, or no treatment. We compared the efficacy of these three modalities and the factors influencing BMD changes and investigated the incidence of pathologic fractures.
Results
In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value: 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%).
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Fig. 2.
Spinal BMD changes in osteoporotic patients (A) and osteopenic patients (B). There is no significant difference according to the treatment modalities in the osteoporotic or osteopenic patients alone. NS, not significant. *Statistically significant change between pre and post transplantation BMD.
Fig. 3.
Spinal BMD change in decreased BMD patients. NS, not significant. *Statistically significant change between pre and post transplantation BMD.
Fig. 4.
Femoral BMD change in decreased BMD patients. NS, not significant. *Statistically significant change between pre and post transplantation BMD.
Table 1.
Patient grouping by preoperative BMD
Table 2.
Pre-transplant characteristics
Table 3.
Post-transplant characteristics
Table 4.
Pre-transplant characteristics of three treatments in decreased BMD patients
Table 5.
Post-transplant characteristics of three treatments in decreased BMD patients
Table 6.
Associated factors of spinal BMD improvement
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