Endocrine Abstracts

Introduction: Low energy trauma fractures are prevalent in end-stage liver disease and after orthotopic liver transplantation (OLT). However, data on bone mineral density (BMD) are scarce in these patients. In this study, we evaluated the natural course of changes in BMD after successful OLT.

Study design: All recipients of a successful OLT between 2000 and 2011 from the Leiden University Medical Centre, in whom BMD data were available, were included. Patients treated with bisphosphonates were censored at start of bisphosphonate therapy (last observation carried forward). Follow-up duration was five years.

Results: The cohort consisted of 223 patients, 69% men, mean age of 50 (17–70 years). Most common primary liver pathology was viral (31%) or alcoholic liver disease (23%). All patients received prednisone, the majority either tacrolimus or cyclosporine. At screening, osteoporosis or osteopenia were found in 18 and 38% of patients at the lumbar spine (LS) and in 10 and 45% of patients at the femoral neck (FN). BMD declined significantly at both sites 6 months after OLT, but increased thereafter at the LS, reaching pre-transplant values at 2 years, and subsequently stabilizing. In contrast, FN BMD declined from 6 months onward, remaining consistently lower than pre-transplant values. The cumulative incidence of osteoporosis at five years after OLT was 14.6% at the LS and 19.6% at the FN.

Conclusion: Osteoporosis and osteopenia are prevalent in patients with end-stage liver disease. An overall decline in BMD is observed within the first 6 months after OLT, with subsequent recovery to pre-transplant values at the LS, but with further decline at the FN. Further investigations are currently underway to elucidate the potential factors responsible for bone loss before and after OLT and to examine the predictive value of changes in BMD for risk of fracture in these patients.