Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis

✍ Scribed by Richard Eastell; E. Rolland Dickson; Stephen F. Hodgson; Russell H. Wiesner; Michael K. Porayko; Heinz W. Wahner; Sandra L. Cedel; B. Lawrence Riggs; Ruud A. F. Krom

• Publisher: John Wiley and Sons
• Year: 1991
• Tongue: English
• Weight: 528 KB
• Volume: 14
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840140215

✦ Synopsis

Atraumatic fractures caused by osteoporosis may be a serious complication of primary biliary cirrhosis. Mean (&S.D.) bone mineral density in the lumbar spine in 210 ambulatory women with primary biliary cirrhosis was 1.02 +: 0.19 gm/cm2, 7% lower than that in 139 age-matched normal women (after adjustment for age and body weight) (p < 0.001). Bone mineral density in the lumbar spine was inversely related to a risk score index of liver disease severity (r = -0.29, p < 0.001). The mean rate of bone loss in 105 of these 210 women was 2%/yr f 4%/yr, twice as great as in the 139 normal women (p < 0.02). In 20 women with primary biliary cirrhosis followed up after orthotopic liver transplantation, bone mineral density in the lumbar spine decreased at 3 mo (p < 0.011, and this decrease may have resulted in atraumatic fractures in 13 of them. Bone mineral density in the lumbar spine then increased (p < 0.01) so that by 12 mo the median bone mineral density in the lumbar spine was similar to that before transplantation and by 24 mo it was 5% above it. Therefore we conclude that the progressive bone loss observed in primary biliary cirrhosis (which is further accentuated immediately after transplantation) may be halted, and the bone mass may be restored toward normal within 2 to 3 yr after orthotopic liver transplantation. (HEPATOLOGY 1991; 14:296-300.)

PBC is a chronic, usually progressive, cholestatic liver disease that predominantly affects young and middle-aged women. The association between PBC and the clinical manifestations of osteoporosis (fractures of vertebrae and long bones) has long been recognized (1).

Small cross-sectional studies (2-4) have suggested that the bone loss occurs early in the course of the liver disease and that osteopenia may be a common complication of PBC. However, there have been no reports of