Vertebral morphometry by X-ray absorptiometry before and after liver transplant: a cross-sectional study

Objectives To evaluate bone density and fracture prevalence in patients wit h end-stage liver diseases (ESLD) awaiting liver transplant and in orthotop ic liver-transplant (OLTx) recipients by using dual energy X-ray absorptiom etry. Design In a cross-sectional study 27 patients (16 males and 11 females, mea n age 49.9 +/- 1.7 years) with ESLD, and 36 subjects (26 males and 10 femal es, mean age 50.5 +/- 1.6 years) who had undergone OLTx 1-70 months before, were recruited. Methods All patients underwent biochemical assessment of mineral metabolism . Bone density measurement of the spine and femur and morphometric X-ray ab sorptiometry (MXA) of the vertebrae were also obtained. Results Bone density was decreased in both groups as compared to the expect ed normal values. Spinal density did not differ between the two groups, whi le femoral bone mass was lower in OLTx than in ESLD patients (T-scores of: femoral neck -1.91 +/- 0.16 vs -1.12 +/- 0.22,P < 0.01; total femur -1.62 /- 0.16 vs -0.94 +/- 0.23, P < 0.02). Bone alkaline phosphatase was the onl y independent predictor of femoral density (R-2 = -0.21, P < 0.05). Symptom atic fractures were reported by 25% of OLTx and 15% of ESLD patients. MXA v ertebral fractures were present In 28% of OLTx and 7.5% of ESLD (P < 0.05) patients. Most of these fractures had been asymptomatic. Total methylpredni solone intake was higher in patients with MXA vertebral fractures than in n on-fractured patients (P < 0.05). Conclusions Fragility fractures, especially of the spine, occur more freque ntly after liver transplantation, with corticosteroid treatment being the m ost important risk factor. Morphometric X-ray absorptiometry represents a u seful technique for identifying vertebral fractures even in liver transplan ted patients. Eur J Gastroenterol Hepatol 13:1201-1207 (C) 2001 Lippincott Williams & Wilkins.