INTRAVENOUS BISPHOSPHONATE PREVENTS SYMPTOMATIC OSTEOPOROTIC VERTEBRAL COLLAPSE IN PATIENTS AFTER LIVER-TRANSPLANTATION

Osteoporosis is common in patients with chronic cholestatic liver dise ase, and atraumatic spinal fracture is a recognized complication after orthotopic liver transplantation. Bisphosphonates are potent inhibito rs of osteoclast bone resorption and have been successfully used to tr eat postmenopausal osteoporosis. We examined whether preoperative bone mineral density can predict the risk of fracture after orthotopic liv er transplantation and whether intravenous bisphosphonate can prevent fractures in high-risk patients. Beginning in February 1993, standard bone mineral density measurements of the lumbar spine were performed a s part of routine pretransplantation assessment. On the basis of a pre liminary analysis from January 1995, patients with a lumbar spine bone mineral density of <0.84 g/cm(2), or <84% of the predicted value (age /sex), were treated with intravenous bisphosphonate (pamidronate disod ium) every 3 months before and for 9 months after liver transplantatio n. Bone mineral density measurements were available in 90 of 136 conse cutive first transplants performed in our unit from February 1993 to S eptember 1996, Before the use of pamidronate, 7 patients sustained sym ptomatic vertebral fractures. Their mean spine bone mineral density wa s lower than in the 38 patients with no clinical evidence of fracture (81.8% +/- 12.3% v94.2% +/- 10.2%; P = .006). Since the introduction o f pamidronate, no symptomatic vertebral fractures have occurred. Of 29 surviving patients with bone mineral density <0.84 g/cm(2) before tra nsplantation, 38% who did not receive treatment with pamidronate suffe red spontaneous fracture, whereas 0 of 13 who received treatment suffe red such a complication. A low lumbar spine bone mineral density is as sociated with a high risk of symptomatic vertebral fracture after live r transplantation. These results suggest that this risk is considerabl y reduced by the administration of intravenous bisphosphonate before a nd after transplantation. Copyright (C) 1998 by the American Associati on for the Study of Liver Diseases.