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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.
08/10/05
Reference
G
Millonig and others. Alendronate in Combination with Calcium
and Vitamin D Prevents Bone Loss After Orthotopic Liver Transplantation:
A Prospective Single-Centre Study." Liver Transplantation.
Published Online: July 20, 2005. Article can be found online
via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantion
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