Clinical

Alendronate prevents bone loss after liver transplantation

Last Updated: 2005-08-12 15:50:13 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Alendronate in combination with calcium and vitamin D prevents the bone loss that commonly follows liver transplantation, according to a report in the August issue of Liver Transplantation.

Osteoporosis commonly complicates advanced-stage liver disease and persists or worsens after liver transplantation, lead author Dr. Gunda Millonig and colleagues from Innsbruck Medical University, Innsbruck, Austria, explain.

They therefore investigated the effects of treatment with alendronate, calcium, and vitamin D in 136 patients who underwent liver transplantation.

Most patients had decreased bone mineral density (BMD) prior to transplantation, the authors report; 23.5% had osteoporosis and 48.5% had osteopenia.

Patients with osteoporosis showed significant gains in lumbar and femoral BMD within the months after liver transplantation, the report indicates, whereas patients with osteopenia had stable lumbar BMD and late increases in femoral BMD after liver transplantation.

Patients with normal BMD at baseline did not receive alendronate after liver transplantation, the researchers note. These patients experienced nonsignificant losses in femoral neck BMD, but not in lumbar BMD, within the first months after liver transplantation.

The risk of fracture after liver transplantation was 5.8%, the results indicate, with all fractures occurring within the first year after the transplant.

Only two patients required discontinuation of alendronate because of side effects, the investigators report.

"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 liver transplantation," the authors conclude. "This is a significant improvement compared to the natural course of bone loss within the first few months after liver transplantation as reported in numerous publications."

"However," the researchers caution, "these results can only be interpreted as hypothesis-generating for the present time, and further randomized studies are needed."

Liver Transpl 2005;11:960-966.