Bone density and metabolism in patients with viral hepatitis and cholestatic liver diseases before and after liver transplantation

OBJECTIVE: Osteoporosis is frequently found in patients with cholestatic li ver disease (primary biliary cirrhosis/primary sclerosing cholangitis) and chronic viral hepatitis. There is limited information about the long-term e ffect of liver transplantation (OLT) on bone metabolism. The aim of this st udy was to investigate the effect of liver transplantation on bone metaboli sm in patients with cholestatic and viral liver diseases. METHODS:We randomly recruited 193 patients with chronic viral hepatitis or cholestatic liver diseases.:Bone density (Z-score) and markers of bone meta bolism (intact parathyroid hormone [iPTH], PTH 70-84, osteocalcin, procolla gen, telopeptide, and vitamin D) were determined before and at time points (< and > 24 months) post-OLT. RESULTS: Before OLT,bone density (Z-score) was decreased in patients with c holestatic (-1) and viral (-0.4) liver diseases. In both groups bone densit y continued to decrease in the periods up to and more than 24 months after OLT. In the cholestatic group, bone density decreased significantly compare d to pre-OLT (p < 0.05) and to the viral hepatitis group (p < 0,001). Marke rs of bone metabolism showed that after OLT, bone metabolism was enhanced a nd shifted versus bone resorption. Immunosuppressive drug therapy (glucocor ticoids, cyclosporin, FK 506) directly correlated with increased bone metab olism post-OLT. CONCLUSIONS: Bone loss is a long-term problem after OLT, particularly in pa tients with cholestatic liver diseases. Drug therapy is a main factor of bo ne loss. Pre- and post-OLT therapy to reduce bone loss is recommended. (Am J Gastroenterol 2000;95:2343-2351. (C) 2000 by Am. Coll. of Gastroenterolog y).