Bone Loss in Liver Transplantees: Relationship with Steroids and PTH

Loss of bone mass is a known complication following liver transplantation. In our previous publications we demonstrated greater alveolar bone loss in liver transplantees compared to healthy controls. Furthermore, those patients also demonstrated greater pocketing and attachment loss. Objectives: To evaluate the relationship between alveolar bone loss (ABL), systemic bone status and calcium-regulating hormones in liver transplantees, and to explore the relationships of these metabolic factors with ABL. Methods: 21 liver transplant patients underwent full clinical and radiologic periodontal examination. The correlations between bone densitometry data, bone metabolic status and drug treatment were examined. Multiple regression analysis was used to determine the association between ABL and these markers. Results: Twelve patients had osteopenia, six were osteoporotic. ABL was 4.33±2.32 mm (range 0.67-9.92). PTH levels ranged from 14 to 106 (mean 55.2±26.4). Six patients had secondary hyperparathyroidism, 13 had chronic renal failure. Mean 25(OH)D3 level was 11.69 ± 4.8, range 10-55 ng/ml. No correlation was found between ABL and current or total dose of glucocorticoids. However, bone loss was inversely related to the duration of treatment (R=-0.474, P=0.03). There was a positive correlation between alveolar bone loss and PTH levels (R=0.419, P=0.059) and the decrease in hip BMD (R=0.482, P=0.027). Using multiple regression analysis, ABL correlated with age, PTH, duration of glucocorticoid treatment and hip bone mineral density loss (R=0.810; P<0.002). Conclusion: Impaired vitamin D status (ranging from deficiency to inadequacy) was observed in all patients. Changes in calcium regulating hormones and hip BMD are correlated with ABL. The above findings stress the importance of assessing these parameters. Therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism in post transplantation patients might also be beneficial in preventing ABL in these patients.