Pamidronate and osteoporosis prevention in liver transplant recipients |
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Authors: | Pietra Pennisi Andrea Trombetti Emiliano Giostra Gilles Mentha René Rizzoli Carmelo E Fiore |
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Institution: | (1) Service of Bone Diseases [WHO Collaborating Center for Osteoporosis Prevention], Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211 Geneva 14, Switzerland;(2) Service of Transplantation, Department of Surgery, University Hospital of Geneva, 1211 Geneva 14, Switzerland;(3) Clinica Medica OVE, University of Catania, Via Plebiscito 628, 95124 Catania, Italy |
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Abstract: | Osteoporosis is a common complication in patients with end-stage liver disease and after orthotopic liver transplantation
(LT), with resulting increasing fracture rate. In this study, we investigated the role of treatment with pamidronate in preventing
further bone loss after LT. Eighty-five patients with end-stage liver disease were included in the study. Pamidronate 30 mg
was given intravenously every 3 months after LT for the duration of 1 year to 43 patients with osteopenia or osteoporosis
prior LT. The remainders served as controls. All patients received a supplementation of calcium and vitamin D. Bone mineral
density (BMD) at the lumbar spine and the femoral neck, and markers of bone metabolism were measured before and 12 months
after LT. Sixty-two BMD were available at 12 months; only paired BMD were evaluated. A significant increase in lumbar spine
BMD was observed in pamidronate treated patients. No change was evident in controls. Femoral neck BMD decreased in both treated
and untreated patients. Osteocalcin serum levels and deoxypyridinoline urinary excretion were significantly reduced by treatment.
Our study suggests that pamidronate decreases bone turnover and is effective in preventing the course of bone loss after LT,
however the efficacy, at the dosage regimen employed and in a follow-up of 12 months, appears to be limited to trabecular
bone, with no effect on the cortical structure of the femur. |
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Keywords: | Liver transplantation Bone mineral density Cortical bone loss Bone turnover Pamidronate |
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