Long-term persistence of low bone density in orthotopic liver transplantation

We determined bone density and metabolism in 46 patients (35 males, 11 fema les) who had undergone liver transplantation 1-48 months previously. Twenty -one patients were then followed for the next 24 months. At each visit, blo od and urine samples for bone and liver metabolism parameters, as well as s pinal and femoral dual-energy X-ray absorptiometry (DXA) scans, were obtain ed. Basal spinal and femoral density was low (p<0.001). Patients with pre-t ransplant cholestatic diseases had lower spinal density than all the other subjects (p<0.05) and the cumulative methylprednisolone intake was an indep endent negative predictor of total hip density (p<0.02). At baseline, urina ry hydroxyproline and N-telopeptide were at the upper normal level and decr eased 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 ob served for both spine and femur after 24 months. After 12 months, femoral b one density was negatively associated with serum cyclosporin A levels (p<0. 005) and cumulative methylprednisolone intake (p<0.05), while the percent d ecrease in spinal density after the first 12 months was negatively predicte d by mean daily methylprednisolone intake (p<0.05). In patients with pre-tr ansplant cholestatic diseases, femoral and spinal density increased after t he 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). Howev er, at the end of the study the cumulative percentage of femoral neck osteo porosis was 43%. In conclusion, an elevated prevalence of spinal and femora l osteoporosis is present even many years after liver transplantation, with immunosuppressive treatment and pre-transplant liver disease being the mos t important pathogenetic factors.