Ng T M, Bajjoka I E
Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, Wayne State University, Detroit, MI, USA.
Ann Pharmacother. 1999 Feb;33(2):233-5. doi: 10.1345/aph.17405.
As patient life expectancy rises after liver transplantation, osteoporosis becomes a significant contributor to morbidity and mortality. Patients who undergo liver transplant have an increased risk of bone fractures secondary to osteoporosis, relative to the general population. Risk factors (pre- and posttransplant) include treatment with steroids, alcohol abuse, smoking, poor nutritional status, immobility, reduced muscle mass, menopause, and hypogonadism. The role of cholestatic liver disease is well recognized, but as of yet, the underlying etiology is unknown. The role of immunosuppressants is also evident, but their exact contribution remains to be established. Currently, there are no established therapies for osteoporosis secondary to liver transplantation. Most of the therapeutic options have been extrapolated from usual treatment options for osteoporosis in the general population. It is reasonable to attempt to lower steroid dosages, especially with the availability of new and more potent immunosuppressants such as mycophenolate mofetil and tacrolimus. Potentially, high-risk patients could be identified early with BMD screening. Preventive measures could be instituted and patients could be monitored more closely for objective signs of osteoporosis, such as decline in BMD and early fractures. Calcium and vitamin D supplementation may be helpful in those with deficiencies or poor nutritional intake, as well as in women older than 25 years. The role of bisphosphonates and hormone replacement therapy remains equivocal as studies in transplant patients are currently lacking. Risk versus benefit must be weighed on an individual basis. Lifestyle measures should be instituted in all patients if possible.
随着肝移植后患者预期寿命的延长，骨质疏松症成为发病和死亡的重要原因。相对于普通人群，接受肝移植的患者因骨质疏松症继发骨折的风险增加。风险因素（移植前和移植后）包括使用类固醇治疗、酗酒、吸烟、营养状况差、活动不便、肌肉量减少、绝经和性腺功能减退。胆汁淤积性肝病的作用已得到充分认识，但迄今为止，其潜在病因尚不清楚。免疫抑制剂的作用也很明显，但其确切贡献仍有待确定。目前，尚无针对肝移植后继发性骨质疏松症的确立疗法。大多数治疗选择是从普通人群中骨质疏松症的常规治疗选择推断而来的。尝试降低类固醇剂量是合理的，尤其是有了诸如霉酚酸酯和他克莫司等新型且更有效的免疫抑制剂。有可能通过骨密度筛查早期识别高危患者。可以采取预防措施，并对患者进行更密切的监测，以观察骨质疏松症的客观体征，如骨密度下降和早期骨折。对于有缺乏症或营养摄入不良的患者以及25岁以上的女性，补充钙和维生素D可能会有帮助。双膦酸盐和激素替代疗法的作用仍不明确，因为目前缺乏针对移植患者的研究。必须根据个体情况权衡风险与益处。如果可能的话，应为所有患者采取生活方式措施。
