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POOR PREDICTION OF OSTEOPOROSIS AFTER HEART OR LIVER TRANSPLANTATION (pp 325, 342)
January 31, 2001The lack of identification of clear risk factors for osteoporotic fractures after organ transplantation reported in this week’s issue of THE LANCET suggests that future post-transplantation treatment should aim to prevent osteoporosis.
Osteoporosis and related fractures are a major complication after organ transplantation. Gudrun Leidig-Bruckner and colleagues from the University of Heidelberg, Germany, aimed to find out the frequency and predictors of osteoporotic fractures after heart or liver transplantation.
In the first and second years after transplantation, the proportion of patients who had at least one vertebral fracture was slightly higher in the heart-transplant group (first year 21%, second year 27%) than in the liver-transplant group (first year 14%, second year 21%). In the third and fourth years, one third of patients from both groups had had one or more vertebral fractures. Non-vertebral fractures occurred in nine patients (7%) after liver transplantation and avascular necrosis of the hip head in three patients (3%) after heart transplantation. In both groups, no dose-dependent effect of immunosuppressive therapy on fracture development could be identified; independent predictors of fracture risk were age and lumbar bone-mineral density in the heart-transplant group, and vertebral fractures before transplantation in the liver-transplant group.
In an accompanying Commentary (p 325), Pierre Delmas from INSERM Research Unit, Claude Bernard University of Lyon, France, comments that the high incidence of osteoporosis (despite calcium and vitamin D supplementation) in most published research in this field highlights the need for more effective therapies in high-risk patients. He suggests that hormone-replacement therapy should be considered as a treatment option in postmenopausal women, and that bisphosphonates – which have been shown to reduce the risk of fracture in postmenopausal women - should be evaluated in these patients.
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