The present study was designed to evaluate the effects of liver transplantation (LT) on the bone mineral density (BMD), characteristics of bone turnover, mineral metabolism and sex hormons. Fifty one patients (34 men, 11 women) aged 43.5 ± 12.1, who underwent LT were studied, assessing the following parameters: lumbar spine and proximal femur BMD, osteocalcin, deoxypyridinoline (DPD), parathyroid hormone (PTH), free testesterone (FT), gonadotropins (FSH, LH), tyroid hormones, growth hormone (GH) and blood/ 24-hours urine Ca and P. All the measures were obtained at baseline and at 3rd month after LT. At baseline, 12 patients (%23.5) had osteoporosis, 22 patients (%43.1) had osteopenia and the mean BMD was 0.892 ± 0.1 for lumbar spine. Whereas, osteoporosis was seen less at femoral neck and total femur: 5 (%9.8) and 4 (%7.8), respectively. Three months after LT, 3.9% drop for lumbar spine, 5.3% drop for femur neck, 6.3% drop for total femur were observed, in BMD these decreases were statistically significant for all sites (p 0.05). The thyroid hormones, GH, PTH, blood Ca, P and osteocalcin levels and urinary DPD excretion were within normal range, while the levels of FSH and LH in women and level of FT in men were lower than normal range. After LT, statistically significant increases were observed in the PTH, osteocalcin, DPD, FSH, LH and FT levels (p 0.05). There was a highly significant negative correlation between duration of liver disease and all the BMD measures (p 0.01). Consequently, the increased osteoporosis ratio which was characterized by high bone turnover was found in patients who underwent LT in this study. The normalization of liver functions following LT was characterized by an early rise in sex hormones.Key words: Osteoporosis, liver transplantation, bone metabolism, gonadal functions
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GIRIS
Osteoporoz kemik kütlesinin azalmasi ve kemigin mikromimarisinin bozulmasiyla karakterize sistemik bir kemik hastaligidir (1). Kemigin kirilganligini artirarak kiriklara sebep olabildiginden organ transplantasyonu sonrasi morbiditenin önemli nedenlerinden biridir. Yapilan çalismalar karaciger transplantasyonu (KCTx) sonrasi kemik kütle kaybinin ilk 3-6 ayda % 48 gibi yüksek rakamlara ulasabildigini göstermektedir (2,3). Etyoloji; primer biliyer siroz, alkolik hepatit ve sklerozan kolanjit gibi primer karaciger hastaliklari yaninda posttransplantasyon döneminde kullanilan kortikosteroid ve immunsupresiflerin kullanimina bagli olabilmektedir. Bunun yaninda D vitamini metabolizmasinin bozulmasi ve hastalarin uzun dönem immobilize olusu da etyolojik faktörler arasinda sayilabilmektedir (4,5,5,6). KCTx sonrasi ilk 6 ayda meydana gelen kiriklar daha çok küçük siddetteki travmalarla ya da travma olmaksizin ortaya çikarlar. En sik omurgada fraktür görülmesine karsilik kostalarda, el bilegi, kalça ve pelviste de % 7- 65’e varan rakamlarda fraktür gelisme olasiligi mevcuttur (7).Bu çalisma KCTx’un hastalarin kemik yogunlugu, metabolizmasi ve hormonal durumu üzerine etkisini arastirmak amaciyla planlanmistir.
