Background Osteoporosis is a frequent complication in patients with chronic liver disease, especially in end-stage and when there is a history or evidence of chronic cholestasis. But even more important is that liver transplant patients, in the first few months after the transplant there may be an accelerated loss of bone mass, which also means greater osteopenia and osteoporosis incidence and fracture risk.
Objectives To study the effect in bone metabolism of antiresorptive treatments in patients undergoing liver transplantation (LT), as well as an evaluation prior to transplant to decrease the risk of osteoporosis.
Methods We collected patients undergoing LT, where data is available at transplant (month 0) and 6–12–18–24 month follow-up after surgery. We collected data of bone metabolism biomarkers, densitometric and antiosteoporotic treatment. Statistical analysis was carried out using R software 3.2.3.
Results We selected 172 patients with LT, and 56 of them had completed the 24 months follow-up. Of the total cohort, 89.7% are men, with a mean age at transplantation of 57.7±6.7 years. The 89% of patients were supplemented with 25-OHVitamin-D after surgery and during follow-up, the 6.4% initiated treatment with bisphosphonates and 2.3% with denosumab.
Improved vitamin D levels and normalization of the values of PTH, beta-CTX and P1NP were observed. The t-score densitometric value for the first 12 months of follow-up dropped slightly, to increase again at 24 months of follow-up. This situation is still more pronounced in lumbar spine (t-score -1.49±1.29 after surgery and -1.29±1.1 at 24 months of follow-up).
Statistical analysis yield a significant influence of antiresorptive treatment (P<0.0001) on the normalization densitometric values, as well as on the normalization of vitD (P=0.003), bCTX (P=0.03) and P1NP (P=0.02). In contrast, obesity correlates with altered densitometric (P=0.003). Finally, there is a clear difference in bone metabolism biomarkers between LT patients evaluated and treated before surgery and those evaluated after surgery (P<0.0001).
Conclusions In general, there is a normalization of serum vitamin D levels and biomarkers of bone metabolism in two years after surgery. The use of antiresorptive treatment is crucial to reach with stage, as well as to establish an evaluation before surgery and treat the patient if is required.
Disclosure of Interest None declared