Service de rhumatologie, département universitaire de rhumatologie, université Nord de France, hôpital Roger-Salengro, CHRU de Lille, Lille, France.
Joint Bone Spine. 2011 Jul;78(4):387-91. doi: 10.1016/j.jbspin.2011.03.001. Epub 2011 May 11.
Osteoporosis is common in liver transplant recipients as a result of both iatrogenic factors and preexisting hepatic osteodystrophy.
To assess the prevalences of osteoporosis and fractures and to identify risk factors for these two abnormalities in patients awaiting liver transplantation for end-stage liver disease.
Between January 2006 and December 2007, patients on a liver transplant waiting list underwent a routine evaluation comprising the identification of risk factors for osteoporosis, radiographs of the spine, bone mineral density measurements (BMD), and laboratory tests (phosphate and calcium levels, hormone assays, liver function tests, and bone turnover markers).
We studied 99 patients (70 males and 20 females; mean age, 55 ± 8 years) including 75% with alcohol-induced cirrhosis with or without hepatocarcinoma. Among them, 36% had radiographic vertebral fractures, 38% had osteoporosis, 35% had osteopenia, and 88% had vitamin D insufficiency or deficiency (25(OH)vitamin D3<20 ng/mL). Lower BMD values were associated with vertebral fractures; the odds ratios and 95% confidence intervals for each BMD decrease of 1 SD were as follows: spine, 1.45 (95%CI, 1.1-1.9); total hip, 2.1 (95%CI, 1.3-3.2); and femoral neck, 2 (95%CI, 1.3-3.1) (P<0.05). Levels of bone resorption markers correlated negatively with BMD at the spine and hip. The Model for End-Stage Liver Disease score correlated negatively with hip BMD.
Our findings suggest high prevalences of low BMD values and vertebral fractures among patients awaiting liver transplantation. Bone status should be evaluated routinely in candidates to liver transplantation.
由于医源性因素和先前存在的肝性骨营养不良，肝移植受者中骨质疏松症很常见。
评估终末期肝病患者等待肝移植时骨质疏松症和骨折的患病率，并确定这两种异常的危险因素。
在 2006 年 1 月至 2007 年 12 月期间，肝移植等待名单上的患者接受了常规评估，包括确定骨质疏松症的危险因素、脊柱 X 光片、骨密度测量（BMD）和实验室检查（磷酸盐和钙水平、激素检测、肝功能检查和骨转换标志物）。
我们研究了 99 名患者（70 名男性和 20 名女性；平均年龄 55 ± 8 岁），其中 75%为酒精性肝硬化，伴有或不伴有肝癌。其中，36%有放射学椎体骨折，38%有骨质疏松症，35%有骨质减少症，88%有维生素 D 不足或缺乏（25(OH)维生素 D3<20ng/mL）。较低的 BMD 值与椎体骨折有关；每个 BMD 降低 1 SD 的比值比和 95%置信区间如下：脊柱，1.45（95%CI，1.1-1.9）；全髋，2.1（95%CI，1.3-3.2）；和股骨颈，2（95%CI，1.3-3.1）（P<0.05）。骨吸收标志物水平与脊柱和髋部的 BMD 呈负相关。终末期肝病模型评分与髋部 BMD 呈负相关。
我们的研究结果表明，等待肝移植的患者中存在低 BMD 值和椎体骨折的高患病率。在候选肝移植者中应常规评估骨骼状况。
