Journal of Clinical Periodontology

Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels


  • Conflict of interest and source of funding statement
    The authors declare that they have no conflict of interests.

Orit Oettinger-Barak
Periodontal Unit
Department of Oral and Dental Medicine
Rambam Health Care Campus 31096
PO Box 9602


Aim: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees.

Patients and Methods: Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined.

Results: Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33±2.32 mm (range 0.67–9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2±26.4). The mean 25(OH)D3 was 11.68±4.7, range 3.5–21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D3 levels geqslant R: gt-or-equal, slanted30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r=−0.474, p=0.03). A positive correlation was found between ABL, PTH (r=0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r=0.810, p=0.004).

Conclusions: The majority of liver transplant patients had insufficient 25(OH)D3 serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.