RT Journal Article
SR Electronic
T1 Predicting bone loss following orthotopic liver transplantation
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 430
OP 434
DO 10.1136/gut.44.3.430
VO 44
IS 3
A1 O M Crosbie
A1 R Freaney
A1 M J McKenna
A1 M P Curry
A1 J E Hegarty
YR 1999
UL http://gut.bmj.com/content/44/3/430.abstract
AB 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 12 months. 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.25(OH)D25-hydroxyvitamin DACRacute cellular rejectionBMDbone mineral densityDPDdeoxypyridinolineFNfemoral neckLSlumbar spineOCosteocalcinOLTorthotopic liver transplantationPICPprocollagen type 1 carboxy propeptidePTHparathyroid hormonePYDpyridinoline