Pitfalls in the diagnosis and management of skeletal complications of liver transplantation

Abstract

In chronic liver diseases, disturbances in liver function, for example in absorption of vitamin D, as well as factors related to the underlying primary liver disease, such as toxicity of alcohol or bile salts, may influence bone turnover. Low bone mass and vertebral fractures are already highly prevalent in patients with end-stage liver disease awaiting liver transplantation. There is rapid bone loss early after transplantation and new vertebral fractures occur in a third of transplanted patients within the first year after transplantation despite significant recovery of bone mass. Neither clinical parameters nor bone turnover markers or bone mineral density could reliably predict the risk of fractures. Furthermore, it is yet unclear how these patients should be treated in order to prevent fractures. Results from our and previous studies suggest that bisphosphonate treatment may decrease bone loss when initiated immediately after transplantation. In conclusion, fractures represent a significant cause of morbidity and mortality so that it is of high clinical relevance to correct all reversible aspects of liver failure to try and avoid the increased bone fragility associated with altered bone quality.