Background Osteoporosis is a frequent complication in patients with chronic liver diseases, mainly in advanced stages or with evidence of cholestasis. During the first few months after liver transplant (LT) it seems that there is an accelerated bone mass loss and greater fracture risk.
Objectives To study the antiresorptive treatment effect in bone metabolism in patients undergoing LT and to evaluate whether medical intervention prior to LT decreases the risk of osteoporosis
Methods We recruited patients from the LT Protocol of Osteoporotic Risk Assessment. The patients were evaluated 3–6 months before surgery, shortly after transplant (month 0) and 6–12–18–24 months after surgery. Data of bone metabolism biomarkers, densitometric values and antiresorptive treatment was collected. Biostatistical analysis with R (3.3.2.) was performed.
Results We selected 163 LT patients of which 86 completed 24 months follow-up. From the total cohort, 77.8% were men and the mean age at transplantation 54.53±9.4 years old. 92.6% of patients were supplemented with vitamin D after surgery and 19.6% initiated antiresorptive treatment. We observed that 25-OHVitamin D, PTH, beta-CTX and P1NP levels were corrected through the follow-up. T-score during the first year of follow-up decreased slightly and at 24 months the tendency was towards increase. This pattern was stronger in lumbar spine (t-score -1.48±1.34 after surgery and -1.28±1.06 at 24 months). Statistical analysis showed that antiresorptive treatment significantly influence lumbar and hip densitometric values (P<0.001 and P<0.001 respectively) as well as P1NP levels (P=0.003 and P=0.012 respectively). Moreover, obesity (P=0.0004), as well as beta-CTX (P=0.029) and 25-OHVitamin D (P=0.024) standardization improved hip densitometric values. Finally, LT patients evaluated before surgery showed better lumbar densitometric values than those evaluated after the transplant (P=0.007).
Conclusions We observed 25-OHVitamin D levels and bone metabolism biomarkers correction during the first two years after LT. Medical intervention prior to LT as well as antiresorptive treatment seem to play a decisive role in bone mineral density improvement.
Disclosure of Interest None declared