Bone Disease in Liver Transplantation
Summary
Osteoporosis and fragility fractures are well-recognized complications of liver transplantation (LT), and can be associated with significant morbidity and mortality. Low bone mass may antedate transplantation, with a number of risk factors contributing to bone loss in patients with chronic liver disease. This chapter focuses on the pathogenesis, assessment, and management of bone disease following LT. Osteopenia, osteoporosis, and vertebral fractures have been documented in patients undergoing assessment for transplantation. Glucocorticoids predominantly affect skeletal health by suppression of bone formation, but bone resorption is increased in the early stages of glucocorticoid therapy. Risk of post-transplantation bone loss and fracture is increased in patients with low pre-transplantation bone mineral density and previous vertebral fracture. Bone density can be measured at a number of skeletal sites, using dual-energy X-ray absorptiometry. Successful management of post-transplantation bone disease involves both optimization of bone health prior to transplant and prophylaxis against bone loss following transplantation.