No association between BMD and prevalent vertebral fractures in liver transplant recipients at time of screening before transplantation

Abstract

Context: Osteoporosis and fractures are prevalent after orthotopic liver transplantation (OLT), but data on these skeletal complications are scarce in patients with end-stage liver disease awaiting liver transplantation.

Objective: To evaluate the prevalence of vertebral fractures (VFs) in OLT recipients at the time of screening for transplantation and to establish the association between bone mineral density (BMD) and these fractures before transplantation.

Design and setting: We conducted a retrospective study of consecutive OLT recipients at the Leiden University Medical Centre between 2000 and 2011 at the time of screening for transplantation. Clinical, laboratory, and BMD data were extracted from electronic hospital records. Conventional spinal radiographs were assessed for VF by two independent observers using Genant's semiquantitative method.

Patients: In total, 162 of the 223 OLT recipients (median age, 51 y; 75% men) who had available BMD and spinal radiographs but who were not receiving bone-modifying treatment at screening for OLT were included in the study.

Main outcome measures: Association between BMD and VF before transplantation.

Results: Osteoporosis and osteopenia were prevalent at the lumbar spine in 19 and 38% of subjects, respectively, and in 10 and 42 % at the femoral neck. VFs, mostly grade 1, were prevalent in 56% of the subjects. There was no association between BMD and prevalent VF before transplantation.

Conclusions: VFs were prevalent in liver transplant recipients at the time of screening for transplantation, but there was no association between BMD and prevalent fractures. Spinal radiographs should be routinely performed as part of screening protocols before liver transplantation to enable identification of VF and allow timely intervention to potentially decrease or prevent skeletal morbidity after transplantation.