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Calcitonin and bisphosphonates treatment in bone loss after liver transplantation

  • Clinical Investigations
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Abstract

Osteopenia is a major complication of orthotopic liver transplantation (OLT). However, no effective therapy for bone disease has been defined. We have studied vertebral bone mineral density (VMD) and fasting serum markers of bone formation [bone gla protein (BGP), procollagen I carboxyterminal peptide (PICP)] and metabolism (serum Ca, P, intact parathyroid hormone (iPTH), 25OHD3 and 1,25(OH)2D3) in 120 patents after OLT. VMD was measured by dual-energy X-ray absorptiometry (DXA) using a Hologic QDR 1000 densitometer on two occasions, 12 months apart. Patients with OLT had a VBD significantly lower compared with age- and sexed-matched Spanish controls (P<0.05). Prevalence of osteoporosis (Z score below-2 SD) was 35.8%. Serum BGP (8.6±0.7 ng/ml) and PICP (222.9±81.9 ng/dl) were higher than those of controls. However, serum calcium, phosphorus, iPTH, 25OHD3, and 1,25(OH)2D3 were within normal range. Patients with osteoporosis were randomly treated with 40 IU/day of calcitonin i.m. (Diatin, Ferrer Int. Laboratories) (n=17) or 400 mg p.o., 15 days every 3 months, of sodium ethiodronate (Difosfen, Rubio Laboratories) (n=23). All patients received 500 mg/12 hours of elemental calcium p.o. After 12 months of treatment, a significant increment of vertebral mineral density (VMD) was observed (6.4% and 8.2%, respectively). Serum BGP and PICP values remained elevated without a difference between the two drugs. Our results indicate that antiresorptive drugs may be of benefit in the high turnover osteoporosis of OLT recipients.

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References

  1. Eastell R, Dickson R, Hodgson SF, Wiesner RH, Porayko MK, Wahner HW, et al (1991) Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis. Hepatology 14:296–300

    Google Scholar 

  2. Porayko MK, Wiesner RH, Hay JE, Krom RAF, Dickson ER, Beaver S, et al (1991) Bone disease in liver transplant recipients: incidence, timing and risk factors. Trans Proc 23:1462–1465

    Google Scholar 

  3. McDonall JA, Dunstan CR, Dilworth P, Sherbon K, Sheil AG, Evans RA, et al (1991) Bone loss after liver transplantation. Hepatology 14:613–619

    Google Scholar 

  4. Hawkins FG, Leon M, López MB, Valero MA, Larrodera L, García I, et al (1994) Bone loss and turnover in patients with liver transplantation. Hepato-Gastroenterol 41:158–161

    Google Scholar 

  5. Diamond TH, Stiel D, Lunzer H, McDowall D, Eckstein RP, Posen S (1989) Hepatic osteodystrophy: static and dynamic bone histomorphometry and serum bone Gla-protein in 80 patients with chronic liver disease. Gastroenterology 96:213–221

    Google Scholar 

  6. Saitta JC, Ott SM, Sherrard DJ, Walden CE, Lipkin EW (1993) Metabolic bone disease in adults receiving long-term parenteral nutrition: longitudinal study with regional densitometry and bone biopsy. JPEN 17:214–219

    Google Scholar 

  7. Stewart AF, Adler M, Byers CM, Segre GV, Broadus AE (1982) Calcium homeostasis in immobilization: an example of resorptive hypercalciuria. N Engl J Med 306:1136–1140

    Google Scholar 

  8. Lukert BP, Raisz LG (1990) Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 112:355–364

    Google Scholar 

  9. Stewart PJ, Stern PH (1989) Cyclosporine: correlation of immunosuppressive activity and inhibition of bone resorption. Calcif Tissue Int 45:222–226

    Google Scholar 

  10. Moskowitz C, Epstein S, Fallon M, Ismail F, Thomas S (1988) Cyclosporin-A in vivo produces severe osteopenia in the rat: effect of dose and duration of administration. Endocrinology 123:2571–2577

    Google Scholar 

  11. Shane E, Epstein S (1994) Immunosuppressive therapy and the skeleton. Trends Endocrinol Metab 5:169–175

    Google Scholar 

  12. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215

    Google Scholar 

  13. Diaz Curiel M, Castro N (1992) On behalf of the proyecto multicétrico de investigación, Madrid 1992. Bone mineral density in the Spanish population measured by dual X-ray absorptiometry (DEXA).

  14. Compton JE, Evans WD, Crawley EO, Evans C (1988) Bone mineral content in normal UK subjects. Br J Radiol 61:631–636

    Google Scholar 

  15. Diamond T, Stiel D, Lunzer M, Wilkinson M, Roche J, Posen S (1990) Osteoporosis and skeletal fractures in chronic liver disease. Gut 31:82–87

    Google Scholar 

  16. Bonkovsky HL, Hawkins M, Stenberg K, Hersh T, Galambos JT, Henderson JM, et al (1990) Prevalence and prediction of osteopenia in chronic liver disease. Hepatology 12:272–280

    Google Scholar 

  17. Lai KC, Goodsitt MM, Murano R, Chesnut H III (1992) A comparison of two dual-energy X-ray absorptiometry systems for spinal bone mineral measurement. Calcif Tissue Int 50:203–208

    Google Scholar 

  18. Riggs BL, Wahner HW, Melton LJ, Richelson LS, Jud HL, Offord KP (1986) Rates of bone loss in the axial and appendicular skeletons of women: evidence of substantial vertebral bone loss prior to menopause. J Clin Invest 77:1487–1491

    Google Scholar 

  19. Hay JE (1993) Bone disease in liver transplant recipients. Gastroenterol Clin North Am 22:337

    Google Scholar 

  20. Shane E, Rivas MC, Silverberg SJ, et al (1993) Osteoporosis after cardiac transplantation. Am J Med 94:257–264

    Google Scholar 

  21. Hay JE, Dickson ER, Weisner RH, Kron RAF (1990) Longterm effect of orthotopic liver transplantation on the osteopenia of primary biliary cirrhosis (abstract). Hepatology 12:838

    Google Scholar 

  22. Watson RGP, Coulton L, Krain JA (1990) Circulating osteocalcin in primary cirrhosis following liver transplantation and during treatment with cyclosporin. J Hepatol 11:354–358

    Google Scholar 

  23. Delmas PD, Wilson DM, Mann KG (1983) Effect of renal function on plasma levels of bone Gla-protein. J Clin Endocrinol Metab 57:1928–1930

    Google Scholar 

  24. Coen G, Mazzaferro S, Ballanti P, et al (1992) procollagen type I C-terminal extension peptide in predialysis chronic renal failure. Am J Nephrol 12:246–251

    Google Scholar 

  25. Kelly PJ, Sambrook PN, Esiman JA (1989) Potential protection by cyclosporin against glucocorticoid effects on bone. Lancet 2:1388

    Google Scholar 

  26. Sambrook PN, Kelly PJ, Keogh AN, et al (1994) Bone loss after heart transplantation: a prospective study. J Heart Lung Transplant 13:116–121

    Google Scholar 

  27. Thiebaud D, Krieg MA, Gillard D, Goy JJ, Burckhardt P (1994) Cyclosporine maintains high-bone turnover with cortical bone loss after heart transplantation. J Bone Miner Res 9:S387

    Google Scholar 

  28. Mazzuoli GF, Posseri M, Gennari C, Minisola S, Antonelli R, Valtorta C (1986) Effect of salmon calcitonin in postmenopausal osteoporosis: a controlled double-blind clinical study. Calcif Tissue Int 38:3–8

    Google Scholar 

  29. Sambrook P, Birminghan J, Kelly P, Kempler S (1993) Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol and calcitonin. N Engl J Med 328:1747–1752

    Google Scholar 

  30. Reid IR, King AR, Alexander LJ, Ibberston HK (1988) Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxpropyllidine)-1,1-bisphosphonate (APD). Lancet 1:143–146

    Google Scholar 

  31. Storm T, Thamsborg G, Steiniche T, Genant HK, Sorensen OH (1990) Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in postmenopausal osteoporosis. N Engl J Med 322:1265–1271

    Google Scholar 

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Authors and Affiliations

  1. Service of Endocrinology, University Hospital, 12 de Octubre, Ctra. de Andalucia Km 5.4, 28041, Madrid, Spain

    M. A. Valero, M. Leon & F. Hawkins

  2. Department of Surgery, University Hospital, 12 de Octubre, Madrid, Spain

    C. Loinaz & E. Moreno

  3. Service of Biochemistry, University Hospital, 12 de Octubre, Madrid, Spain

    L. Larrodera

Authors
  1. M. A. Valero
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  2. C. Loinaz
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  3. L. Larrodera
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  4. M. Leon
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  5. E. Moreno
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  6. F. Hawkins
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Valero, M.A., Loinaz, C., Larrodera, L. et al. Calcitonin and bisphosphonates treatment in bone loss after liver transplantation. Calcif Tissue Int 57, 15–19 (1995). https://doi.org/10.1007/BF00298990

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  • DOI: https://doi.org/10.1007/BF00298990

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