Table 2.

Treatment Options for Liver Transplant Recipients with Osteoporosis.

		Adult dose and route of administration	Comments
Bisphosphonates	Alendronate	70 mg per oral once a week for maximum 5 years	GI intolerance, hypocalcaemia, osteonecrosis of jaw (rare), atypical femur fracture (rare). Liver safe
	Ibandronate	150 mg per oral once a month for maximum 5 years (IV form also available)	Same as above
	Risedronate	5 mg per oral daily for maximum 5 years	Same as above
	Zoledronic acid	5 mg IV slow infusion over 5 min, once a year for 5 years	Infusion reactions (in addition to the above)
Hormonal therapy	Teriparatide	20 μg/day Subcutaneously daily for less than 2 years	Watch for hypercalcemia, renal impairment. Liver safe
	Raloxifene	Not studied in post-liver transplant setting—not preferred	Vaginal bleeding, hot flushes, deep vein thrombosis, coronary artery disease.
	Testosterone	Not studied in post-liver transplant setting—not preferred	Causes LFT derangement Interaction with cyclosporine, tacrolimus and glucocorticoids
	Calcitonin	100 IU intranasal daily or 200 IU S.C or I.M for 3–5 years	Not first choice as it is not most effective
Others	Vitamin D	50,000 IU per oral once a week for 8 weeks	Ideal to correct vitamin D deficiency for optimal response to bisphosphonate
	Calcium	500–1000 mg per oral/day
	Denosumab	60 mg subcutaneous once every 6 months for a period of 5 years	Liver safe, caution while using along with immunosuppression

GI, gastrointestinal; LFT, liver function test.