Background Bone loss is an important complication for both patients with chronic liver diseases and after orthotopic transplantation. This bone fragility increases the risk of vertebral and non-vertebral fractures, morbidity and mortality [1,2].
Objectives The aim of this study was to determine the incidence of non-traumatic vertebral fractures following liver transplantation.
Methods We performed a prospective, descriptive, cohort study including all the patients with severe chronic liver diseases, who were awaiting liver transplantation. Patients were seen before transplantation (pre-transplant group, visit 1) and ≥ one year after transplantation (post-transplant group, visit 2). At each visit, risk factors of osteoporosis were collected and bone mineral density was assessed. Vertebral fractures were identified using Vertebral Fracture Assessment. Biochemical tests including bone turnover markers were performed at each visit.
Results 115 patients were in the pre-transplant group and 33 in the post-transplant group. In the pre-transplant group, the prevalence of vertebral fractures and non-vertebral fractures was 24.5% and 17.4%, respectively. The prevalence of osteoporosis was higher at lumbar spine as compared to femoral neck (13.5% versus 8.9%). In the post-transplant group, the prevalence of vertebral fractures at visit 1 and visit 2 was 33.3% and 60.6% respectively, with an incidence of 23.1 fractures per 100 patientyears. Bone mineral density decreased significantly after transplantation (7.97% - 0.075 g/cm2). Markers of bone turn-over suggested a high level of bone remodeling.
Conclusions Bone fragility is highly prevalent in patients awaiting liver transplantation and worsens ≥ one year after transplantation. Bone status should be evaluated in all patients with severe liver disease awaiting transplantation to identify patients at high risk of fracture and help clinicians to prescribe appropriate preventive treatment.
Wibaux C, Legroux-Gerot I, Dharancy S, Boleslawski E, Declerck N, Canva V, et al. Assessing bone status in patients awaiting liver transplantation. Joint Bone Spine. 2011;78(4):387-391.
Krol CG, Dekkers OM,Kroon HM, Rabelink TJ, van Hoek B, Hamdy NAT. Longitudinal changes in BMD and fracture risk in orthotopic liver transplant recipients not using bone modifying treatment. J Bone Miner Res. 2014;29(8):1763-1769.
Disclosure of Interest None declared