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. 1999 Mar;44(3):430–434. doi: 10.1136/gut.44.3.430

Predicting bone loss following orthotopic liver transplantation

O Crosbie 1, R Freaney 1, M McKenna 1, M Curry 1, J Hegarty 1
PMCID: PMC1727429  PMID: 10026333

Abstract

BACKGROUND—Hepatic osteodystrophy occurs in the majority of patients with advanced chronic liver disease with the abnormalities in bone metabolism accelerating following orthotopic liver transplantation (OLT). 
AIMS—To examine changes in bone mineral density (BMD) following OLT and to investigate factors that lead to bone loss. 
METHODS—Twelve patients had BMD (at both the lumbar spine (LS) and femoral neck (FN)) and biochemical markers measured preoperatively and for 24 months following OLT. 
RESULTS—BMD was low in 75% of patients prior to OLT and decreased significantly from baseline at the LS at three months and the FN at six months. BMD began to increase thereafter at both sites, approaching baseline values at the LS by 12 months. Bone formation markers, osteocalcin and procollagen type I carboxy propeptide, decreased immediately post-OLT, with a concomitant increase seen in the resorption markers pyridinoline and deoxypyridinoline. This resulted in a negative uncoupling index early post-OLT, that rebounded to positive values after six months. There was a significant correlation between the change in the uncoupling index between six and three months which preceded the increase in BMD at 12months. The decrease in BMD recorded early post-OLT correlated with vitamin D levels at three months. 
CONCLUSIONS—Results suggest that increased resorption and inadequate formation are the major contributors to additional bone loss following OLT. Non-invasive biochemical markers precede later changes in BMD in this patient group following OLT and may have a role in investigating and planning intervention strategies to prevent bone loss in future studies. 



Keywords: liver transplantation; bone mineral density; bone resorption

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Figure 1 .

Figure 1

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Lumbar spine and femoral neck bone mineral density T-values at baseline and after OLT for 12 patients. 


Figure 2 .

Figure 2

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Uncoupling index (OC minus DPD, T-values) at baseline and after OLT for 12 patients. 


Figure 3 .

Figure 3

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Correlation between changes in uncoupling index (OC minus DPD) at 3-6 months, and lumbar spine bone mineral density at 3-12 months for eight patients (r=0.766, p<0.05). 


Figure 4 .

Figure 4

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Changes in uncoupling index (OC minus DPD) preceding improvement in lumbar spine bone mineral density, shown here for patient 1. 


Figure 5 .

Figure 5

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Changes in uncoupling index (OC minus DPD) and LS bone mineral density for patient 3. Arrows indicate clinical events (relapse of ulcerative colitis and surgery for small bowel obstruction) which preceded a fall in both the uncoupling index and BMD seen at 24 months. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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