Predominant factors associated with bone loss in liver transplant patients – after prolonged post-transplantation period


Corresponding author: S. Ish-Shalom, Metabolic Bone Diseases Unit, Rambam Medical Center, P.O. Box 9602, 31096 Haifa, Israel. Tel.: +972-4-854-2584; fax: +972-4-854-3416; e-mail:


Abstract: Introduction: Osteoporosis is a major cause of morbidity in liver transplant recipients and is associated with multiple factors.

Objectives: To evaluate bone mineral density (BMD), bone turnover and calcium-regulating hormones in 29 patients (17 men, 12 women) 2–12 yrs following liver transplantation for non-alcoholic liver diseases.

Results: Fifteen patients (52%) were on immunosuppressive treatment with tacrolimus and 14 (48%) with cyclosporine. Eleven patients (38%) were currently on prednisone, 18 patients (62%) had stopped glucocorticoid treatment 6 months to 11 yrs prior to the study. Nineteen patients (65.5%) had decreased BMD according to WHO criteria, 17 (58.2%) at the femoral neck, 13 (44.8%) at the lumbar spine. Nineteen patients (65.5%) had a subnormal (<15 ng/mL) serum level of 25 (OH) D3. These patients had significantly lower BMD at the femoral neck (p = 0.02). Femoral neck BMD negatively correlated with serum parathyroid hormone level (p = 0.06, r = −0.35), length of the post-transplantation period (p = 0.025, r = −0.416) and duration of glucocorticoid treatment (p = 0.029, r = −0.406), regardless of its cumulative dose. Symptomatic fractures were less frequent in tacrolimus treated patients than in cyclosporine users (p = 0.03).

Conclusions:  Decreased BMD is frequent following liver transplantation and is affected by vitamin D deficiency, cyclosporine use, and the duration of glucocorticoid therapy, but not by its cumulative dose. Achievement and maintenance of optimal vitamin D status and shortening of glucocorticoid treatment period may have a favorable effect on bone preservation.