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Mechanism of Bone Loss After Liver Transplantation: A Histomorphometric Analysis
Author(s) -
Vedi Shobna,
Greer Shaun,
Skingle Susan J.,
Garrahan Nigel J.,
Ninkovic Mary,
Alexander Graeme A.,
Compston Juliet E.
Publication year - 1999
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1359/jbmr.1999.14.2.281
Subject(s) - cancellous bone , bone remodeling , osteoid , medicine , transplantation , resorption , bone resorption , liver transplantation , osteoporosis , bone disease , surgery , urology
Organ transplantation is associated with increased bone loss and high fracture risk, but the pathophysiological mechanisms responsible have not been established. We have performed a histomorphometric analysis of bone remodeling before and 3 months after liver transplantation in 21 patients (14 male, 7 female) aged 38–68 years with chronic liver disease. Eight‐micrometer undecalcified sections of trans‐iliac biopsies were assessed using image analysis. Preoperatively, bone turnover was low with a tendency toward reduced wall width and erosion depth. The bone formation rate increased from 0.021 ± 0.016 (mean ± SD) to 0.067 ± 0.055 μm 2 /μm/day after transplantation ( p < 0.0002) and activation frequency from 0.24 ± 0.21/year −1 to 0.81 ± 0.67/year −1 ( p < 0.0001). No significant change was observed in wall width, but there was a trend toward an increase in indices of resorption cavity size. There was a small increase in osteoid seam width postoperatively ( p < 0.02) and decrease in mineralization lag time ( p < 0.001). No significant changes in indices of cancellous bone structure were observed in the postoperative biopsies. These results demonstrate a highly significant and quantitatively large increase in bone turnover in the first 3 months after liver transplantation. Although no significant disruption of cancellous bone structure was demonstrated during the time course of the study, the observed changes in bone remodeling predispose to trabecular penetration and may thus result in long‐term adverse effects on bone strength.