A controlled trial of calcitonin therapy for the prevention of post-liver transplantation atraumatic fractures in patients with primary biliary cirrhosis and primary sclerosing cholangitis

Background/Aims: Accelerated bone loss occurs early after liver transplanta tion (OLT) and, in cholestatic patients with pre-existing osteopenia, cause s spontaneous fracturing. This study aimed to investigate the efficacy of c alcitonin, a powerful inhibitor of bone resorption, in preventing or reduci ng the accelerated rate of bone loss and fracturing which occurs in patient s with primary biliary cirrhosis and primary sclerosing cholarigitis early after OLT. Methods: Sixty-three patients undergoing OLT for primary biliary cirrhosis (n = 26) and primary sclerosing cholarigitis (n = 37) were randomized to re ceive: (a), 100 IU/day of salmon calcitonin subcutaneously for the first 6 months posttransplant; or (b), no therapy. At pretransplant, and at 4 and 1 2 months after OLT, patients were investigated clinically, biochemically, b y bone mineral density of the lumbar spine, and by radiographs of the thora columbar spine, chest and site of any bone pain. Results: The bone mineral density of the lumbar spine fell equally at 4 mon ths in both groups, from 0.85 to 0.81 g/cm(2) in calcitonin-treated patient s (n = 29) and from 0.88 to 0.82 g/cm(2) in controls (n = 34); at 12 months , both groups had stabilized to 0.83 g/cm(2). Fracturing was the same in bo th groups. Conclusions: Calcitonin therapy for the first 6 months after OLT is unable to prevent or reduce accelerated bone loss or spontaneous fractures which o ccur in the first posttransplant year. (C) 2001 European Association for th e Study of the Liver. Published by Elsevier Science B.V. All rights reserve d.