Frequency and predictors of osteoporotic fractures after cardiac or liver transplantation: a follow-up study

Background Osteoporosis and related fractures are a major complication afte r organ transplantation. The aim of this study was to find out the frequenc y and predictors of osteoporotic fractures after cardiac or liver transplan tation. Methods 235 consecutive patients who had a cardiac transplant (n=105; 88 me n, 17 women) or a liver transplant (130; 75 men, 55 women) were followed. V ertebral fractures were assessed by a standardised analysis of spinal radio graphs before and annually after transplantation. Clinical and non-vertebra l fracture data were noted from hospital records. Findings in the first and second years after transplantation, the proportio n of patients (Kaplan-Meier estimates) who had at least one Vertebral fract ure was slightly higher in the cardiac group (first year 21%, second year 2 7%) than in the liver group (first year 14%, second year 21%). in the third and fourth years, one third of patients from both groups had had one or mo re vertebral fractures. Non-vertebral fractures occurred in nine patients ( 7%) after liver transplantation and avascular necrosis of the hip head in t hree patients (3%) after cardiac transplantation. In both groups, no dose-d ependent effect of immunosuppressive therapy on fracture development could be identified. Independent predictors assessed by multivariate analysis wer e age (hazard ratio [95% CI] increase of 5 years, 1.71 [1.1-2.7]) and lumba r bane-mineral density (decrease of 1 SD t score, 1.97 [1.2-3.2]) in cardia c transplantation patients, and vertebral fractures before transplantation (6.07 [1.7-21.7]) in the liver group. Interpretation The high frequency of osteoporotic fractures in the 2 years after transplantation and the limitations of reliable fracture-risk predict ions, show the need to investigate preventive therapies.