Bone Loss After Liver Transplants Can Be Prevented

The results of this study appear in the August 2005 issue of LiverTransplantation, the official journal of the American Association forthe Study of Liver Diseases (AASLD) and the International LiverTransplantation Society (ILTS). The journal is published on behalf ofthe societies by John Wiley & Sons, Inc. and is available onlinevia Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantion.

Osteoporosis occurs in a large number of patients with end stage liverdisease, and is often worsened by the immunosuppressive drugs normallygiven to prevent rejection following liver transplants. To date,however, studies have not been conducted and no guidelines exist forthe treatment of bone loss following liver transplant.

In order to determine the effectiveness of medication in preventingbone loss after liver transplants, researchers led by Gunda Millonig ofthe Department of Gastroenterology and Hepatology at Innsbruck MedicalUniversity in Innsbruck, Austria, assessed osteoporosis in 136pre-liver transplant patients between January 1999 and December 2003.All patients on the waiting list were given 1000 mg of calcium and 400IE of vitamin D daily, and bisphosphonate (alendronate, the drug usedto treat osteoporosis) was given following liver transplant to thosepatients who had either osteopenia (a decrease in bone density that canlead to osteoporosis) or osteoporosis before transplant. Patients whoseBMD decreased following the transplant were also given bisphosphonate.

"The striking result of this study was that alendronate combined withcalcium and vitamin D almost completely prevented further bone loss inthe first 4 months after LT [liver transplant]," the authors state."This is a significant improvement compared to the natural course ofbone loss within the first few months after LT as reported in numerouspublications." In addition, patients with osteopenia and osteoporosis,which accounted for 72 percent of the patients in the study, remainedstable on the alendronate therapy for the first four months aftertransplant and showed significantly improved BMD over the next threeyears, although for the most part their BMD did not ever reach normallevels.

"Our study suggests that oral alendronate therapy immediately after LTin patients with osteoporosis/osteopenia is effective in preventingbone loss subsequent to LT," the authors conclude. They note, however,that while the results are promising, further randomized studies areneeded.

Article: "Alendronate in Combination with Calcium and Vitamin DPrevents Bone Loss After Orthotopic Liver Transplantation: AProspective Single-Centre Study," Gunda Millonig, Ivo W. Graziadei,Dagmar Eichler, Karl-Peter Pfeiffer, Gerd Finkenstedt, PetraMuehllechner, Alfred Koenigsrainer, Raimund Margreiter, Wolfgang Vogel,Liver Transplantation; August 2005; Published Online: July 20, 2005.Article can be found online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantion.