Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Bone mass continues to increase in liver transplant patients, despite early loss

07.09.2006
A new study on bone loss in patients with liver disease before and after transplant found that those with the lowest bone density before transplant showed the most improvement afterwards. It also showed that bone loss immediately following transplant was common and identified several risk factors for post-transplant bone loss.

The results of this study appear in the September 2006 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

Osteoporosis and osteopenia, its less severe form, are known complications of cirrhosis, especially in patients with cholestatic liver disease (where bile production stops). However, the underlying mechanism of bone loss in these patients is poorly understood and osteoporosis is often overshadowed by the more pressing health problems seen with liver disease. Early aggressive bone loss occurs in almost all patients following transplant, and although immunosuppression is assumed to play a role in bone loss, risk factors have not been well established to date.

In the largest cohort of patients reported to date that were transplanted at a single center, Maureen M. J. Guichelaar of the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, MN and her colleagues studied 360 adult patients undergoing liver transplants at the Mayo Clinic between 1985 and 2001. All of the patients were diagnosed either with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC), where the bile ducts become inflamed and obstructed, causing bile to build up in the liver and damage it. Patients were examined before transplant, at 4 and 12 months following transplant, and every year thereafter. The exam included liver function status, nutritional status, bone marrow density, muscle wasting and complications. All patients were prescribed calcium supplements and vitamin D, if needed. Patients received different immunosuppressive therapies, depending on when the transplant took place.

Only 23 percent of patients had normal bone mass before undergoing a transplant, with a higher prevalence of osteoporosis among those with PBC. Four months after transplant, 51 percent of the patients had osteoporosis, but bone mineral density (BMD) increased for up to 4 years after transplant and remained above pre-transplant levels. The risk factors linked to increased bone loss during the first 4 months after transplant were PSC, younger age at transplant, no inflammatory bowel disease before transplant, smoking, higher pre-transplant bone density, and shorter duration of liver disease before transplant. Bone gain during the first two years after transplantation was greater for patients who were pre-menopausal; had lower pre-transplant and/or 4-month post-transplant bone densities; received lower doses of glucocorticoids; and had higher blood levels of vitamin D.

The authors note that the aggressive bone loss that occurred during the first 4 months did not change over time despite changes in immunosuppressive therapies. "In conclusion," they state, "patients transplanted most recently have improved bone mass before OLT [orthotopic liver transplantation], and although bone loss still occurs early after OLT, these patients also have a greater recovery in BMD over the years following OLT."

In an accompanying editorial in the same issue, Wolfram Karges and Christian Trautwein of the Department of Internal Medicine at RWTH University Hospital Aachen in Germany note that the study showed that absolute bone mass was higher after liver transplantation than before, approaching BMD values typical of healthy individuals of the same age. "This novel observation is reassuring and rewarding, as it demonstrates that OLT, despite concomitant immunosuppression, is overall suitable to treat cholestatic osteopenia," they state. However it is not enough. "To secure the benefits of OLT on bone mass, and to reduce the risk of fracture after OLT, therapeutic intervention is mandatory," they urge, advocating that patients with progressive liver disease should be treated very early, whether or not they will need a transplant. "Eventually, the prevention of fragility fractures, and not the improvement of bone mineral density, is the ultimate clinical goal for patients with osteoporosis," the conclude, adding that future studies should explore other factors than those described in the present study, namely those that would help reduce the risk of falls and fractures.

David Greenberg | EurekAlert!
Further information:
http://www.interscience.wiley.com/journal/livertransplantation

More articles from Studies and Analyses:

nachricht Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT

nachricht Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Electron highway inside crystal

Physicists of the University of Würzburg have made an astonishing discovery in a specific type of topological insulators. The effect is due to the structure of the materials used. The researchers have now published their work in the journal Science.

Topological insulators are currently the hot topic in physics according to the newspaper Neue Zürcher Zeitung. Only a few weeks ago, their importance was...

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

Researchers identify potentially druggable mutant p53 proteins that promote cancer growth

09.12.2016 | Life Sciences

Scientists produce a new roadmap for guiding development & conservation in the Amazon

09.12.2016 | Ecology, The Environment and Conservation

Satellites, airport visibility readings shed light on troops' exposure to air pollution

09.12.2016 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>