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 Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

nachricht Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester

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: Fizzy soda water could be key to clean manufacture of flat wonder material: Graphene

Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.

As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...

Im Focus: Exotic quantum states made from light: Physicists create optical “wells” for a super-photon

Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.

Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...

Im Focus: Circular RNA linked to brain function

For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.

While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...

Im Focus: RAVAN CubeSat measures Earth's outgoing energy

An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.

The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...

Im Focus: Scientists shine new light on the “other high temperature superconductor”

A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.

Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Call for Papers – ICNFT 2018, 5th International Conference on New Forming Technology

16.08.2017 | Event News

Sustainability is the business model of tomorrow

04.08.2017 | Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

 
Latest News

A Map of the Cell’s Power Station

18.08.2017 | Life Sciences

Engineering team images tiny quasicrystals as they form

18.08.2017 | Physics and Astronomy

Researchers printed graphene-like materials with inkjet

18.08.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>