RESUMO
BACKGROUND: Bone loss after liver transplant (LT) is a long-term problem associated with an increased morbidity due to pathologic fractures. We reviewed our management of post-LT bone loss. METHODS: We collected retrospective data from 82 adult LT recipients between January 2006 and December 2009 who had preoperative and postoperative (12 to 24 months) bone mineral density (BMD) data measured by dual energy X-ray absorptiometry (DXA). BMD was decreased in 52 out of 82 patients before LT. These patients were managed with calcium plus alendronate, calcium only, or no treatment. We compared the efficacy of these three modalities and the factors influencing BMD changes and investigated the incidence of pathologic fractures. RESULTS: In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value: 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%). CONCLUSIONS: Weekly alendronate with daily calcium may be helpful for the spinal bone mineral protection in preoperative patients with decreased BMD.
Assuntos
Adulto , Humanos , Absorciometria de Fóton , Alendronato , Densidade Óssea , Cálcio , Fraturas Espontâneas , Incidência , Fígado , Transplante de Fígado , Análise Multivariada , Osteoporose , Estudos Retrospectivos , TransplantesRESUMO
BACKGROUND: Bone loss after liver transplant (LT) is a long-term problem associated with an increased morbidity due to pathologic fractures. We reviewed our management of post-LT bone loss. METHODS: We collected retrospective data from 82 adult LT recipients between January 2006 and December 2009 who had preoperative and postoperative (12 to 24 months) bone mineral density (BMD) data measured by dual energy X-ray absorptiometry (DXA). BMD was decreased in 52 out of 82 patients before LT. These patients were managed with calcium plus alendronate, calcium only, or no treatment. We compared the efficacy of these three modalities and the factors influencing BMD changes and investigated the incidence of pathologic fractures. RESULTS: In decreased BMD patients (n=52), the postoperative spinal BMD was increased with all three treatment modalities. A more significant increase was found with ALN treatment (+0.103) compared to NO treatment (+0.029) (P-value: 0.016). However, femoral BMD decreased despite ALN treatment. Alendronate use was a significant factor for post-LT spinal BMD improvement in the univariate and multivariate analysis. There were significant newly-developed pathologic fractures after LT especially in osteoporotic patients (28%). CONCLUSIONS: Weekly alendronate with daily calcium may be helpful for the spinal bone mineral protection in preoperative patients with decreased BMD.