Predictive Factors Analysis of Osteoporosis and Fragility Fractures After Liver Transplantation

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In liver transplant recipients, a fragility fracture caused by osteoporosis due to administration of immunosuppressive agents and aging leads to a decrease in ADL. The recipients with the fragility fracture exhibit sometimes poor prognosis. We analyzed predictive factors of the postoperative fragility fracture and osteoporosis in 247 liver transplant recipients in our department. Lumbar spine T score and young adult mean (YAM), which are criteria for osteoporosis diagnosis, were calculated in 45 patients who measured postoperative bone mineral density (BMD). The incidence in the postoperative fragility fracture between both groups with and without osteoporosis was significantly different, 88.2 vs 14.3% (p<0.0001). There were no significant difference in bone metabolism marker abnormality (serum Ca, P, iPTH), sex, presence or absence of menopause, BMI, hepatic viral primary disease and administration duration of steroid or diuretics between both groups with and without osteoporosis. However, the incidence of osteoporosis in alcoholic cirrhosis groups was significantly higher than that in non-alcoholic groups, 23.5 vs 3.8% (p=0.039). In addition, single nucleotide polymorphisms (SNP) of vitamin D receptor (VDR; Fok 1, Apa 1, Bsm 1, Taq 1) related to bone metabolism were analyzed in the 141 recipients. 88.9% of cases with osteoporosis was VDR (Bsm 1) bb genotype, whereas 55.6% of cases without osteoporosis was bb genotype (p = 0.0495). In addition, the population of VDR (Taq 1) TT genotype in the group with the fragility fracture was significant lower than that in the no fracture group (p = 0.0114). These results suggest that presence of alcoholic cirrhosis and the VDR (Bsm1) bb genotype group may be a predictive factor of osteoporosis development. Analysis of SNPs of VDR might be useful for risk assessment of osteoporosis and earlier therapeutic intervention.

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