Caring for the Bone Health Among Liver Transplant Recipients

Abstract

Liver transplant outcomes have improved over the years, and currently, the quality of life and long-term well-being of these patients needs to be improved. Improving bone health goes a long way toward achieving this objective. Poor bone health (osteopenia and osteoporosis) although prevalent, is often overlooked owing to its asymptomatic nature. It can be complicated by debilitating fracture affecting quality of life. It is recommended to assess and optimize bone health prior to liver transplant. Multiple factors contribute to poor bone health in a liver transplant recipient and it is vital to understand and ameliorate these. A careful and targeted approach with inputs from multidisciplinary team involving transplant physician, endocrinologist, occupational therapist, nutritionist, and nursing personnel may often be required. In this review, we aim to concisely discuss the various aspects related to prevalence, pathophysiology, evaluation, treatment, and follow-up of bone disease among liver transplant recipients.

Keywords: bisphosphonates; bone health; cirrhosis; liver transplant recipients; vitamin D.

Figure 1

Factors causing poor bone health in a patient with cirrhosis undergoing liver transplant. IGF-1, insulin like growth factor 1; PBC, primary biliary cirrhosis; PSC, primary sclerosing cirrhosis; TDF, Tenofovir disproxil fumarate.

Figure 2

Evaluation of bone health in a liver transplant recipient. BMD, bone mineral density; DXA, Dual energy X-ray absorptiometry.