Atamaz F, Hepguler S, Karasu Z, Kilic M, Tokat Y
Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-Izmir, Turkey.
Transplant Proc. 2006 Jun;38(5):1448-52. doi: 10.1016/j.transproceed.2006.02.074.
The aim of this study was to prevent fractures in the first postoperative year.
We studied 59 patients (48 men, 11 women) aged 42.6+/-11.4 years, who underwent liver transplantation. All patients received oral alendronate 70 mg weekly and calcium 1 g and calcitriol 0.5 mug daily. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine and proximal femur at baseline as well as at 6 and 12 months after transplantation for comparison with an historical control group (n=31). Spinal radiographs were obtained to assess vertebral fractures at the same time. Additionally, serum osteocalcin, serum parathyroid hormone (PTH), urinary deoxypyridinoline (DPD), and biochemical parameters were determined every 3 months.
At baseline, femoral total BMD of men was significantly greater than that of women (P<.05, .85+/-.1 vs .74+/-.1). A significant increase in BMD was observed at 12 months (P<.05), no patient developed a bone fracture. Comparison analysis of genders showed that there was a significant difference in favor of men (P<.05). The lumbar BMD, neck T-, and Z-scores were significantly higher among patients treated with alendronate than historical controls (P<.05). After 3 months, serum PTH was increased and serum osteocalcin and urinary DPD were reduced. No severe side effects from alendronate treatment were observed during the study.
A direct sign of the success of our study was no fracture observed during the first postoperative year. Alendronate should be considered for patients with low bone mass after liver transplantation.
本研究的目的是预防术后第一年发生骨折。
我们研究了59例接受肝移植的患者（48例男性，11例女性），年龄为42.6±11.4岁。所有患者每周口服阿仑膦酸钠70mg，每日口服钙剂1g和骨化三醇0.5μg。在基线以及移植后6个月和12个月时，通过双能X线吸收法测量腰椎和股骨近端的骨密度（BMD），并与历史对照组（n = 31）进行比较。同时拍摄脊柱X线片以评估椎体骨折情况。此外，每3个月测定血清骨钙素、血清甲状旁腺激素（PTH）、尿脱氧吡啶啉（DPD）以及生化指标。
在基线时，男性的股骨总骨密度显著高于女性（P <.05，0.85±0.1 vs 0.74±0.1）。在12个月时观察到骨密度显著增加（P <.05），无患者发生骨折。性别比较分析显示男性更具显著差异（P <.05）。接受阿仑膦酸钠治疗的患者腰椎骨密度、颈部T值和Z值显著高于历史对照组（P <.05）。3个月后，血清PTH升高，血清骨钙素和尿DPD降低。在研究期间未观察到阿仑膦酸钠治疗的严重副作用。
我们研究成功的一个直接标志是术后第一年未观察到骨折。肝移植后骨量低的患者应考虑使用阿仑膦酸钠。
