Bone loss after liver transplants can be prevented

A new study found that the drug used to treat osteoporosis, when used in combination with calcium and vitamin D, can prevent the additional bone loss that commonly occurs after liver transplants. The treatment also helped stabilize bone loss in patients who already had osteoporosis, and helped improve their bone mineral density (BMD).

The results of this study appear in the August 2005 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/livertransplantion.

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

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

“The striking result of this study was that alendronate combined with calcium and vitamin D almost completely prevented further bone loss in the first 4 months after LT [liver transplant],” the authors state. “This is a significant improvement compared to the natural course of bone loss within the first few months after LT as reported in numerous publications.” In addition, patients with osteopenia and osteoporosis, which accounted for 72 percent of the patients in the study, remained stable on the alendronate therapy for the first four months after transplant and showed significantly improved BMD over the next three years, although for the most part their BMD did not ever reach normal levels.

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