간이식 후 골다공증 관리
Management of Osteoporosis in Liver Transplant Recipients
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results:A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by −7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusion: Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.
Abstract
Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results:A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by −7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusion: Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.
참고문헌 (24)
- Lee Y, "Post-transplantation osteoporosis", J Korean Soc Transplant, 25(4), pp.239~244 (2011)
- Desai R, "Quality of life up to 30years following liver transplantation", Liver Transpl, 14(10), pp.1473~1479 (2008)
- Sheiner PA, "Long-term medical complications in patients surviving > or =5 years after liver transplant", Transplantation, 69(5), pp.781~789 (2000)
- Navasa M, "Quality of life, major medical complications and hospital service utilization in patients with primary biliary cirrhosis after liver transplantation", J hepatol, 25(2), pp.129~134 (1996)
- van Staa TP, "Oral corticosteroids and fracture risk : relationship to daily and cumulative doses", Rheumatology, 39(12), pp.1383~1389 (2000)
- Weinstein RS, "Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids potential mechanisms of their deleterious effects on bone", J Clin invest, 102(2), pp.274~282 (1998)
- Kanda J, "Effects of the calcineurin inhibitors cyclosporine and tacrolimus on bone metabolism in rats", Biomed Res, 39(3), pp.131~139 (2018)
- Stern PH, "The calcineurin-NFAT pathway and bone : intriguing new findings", Mol interv, 6(4), pp.193~196 (2006)
- Ebeling PR, "Approach to the patient with transplantation-related bone loss", J Clin Endocrinol Metab, 94(5), pp.1483~1490 (2009)
- Kanis JA, "Interpretation and use of FRAX in clinical practice", Osteoporos int, 22(9), pp.2395~2411 (2011)
- Kanis JA, "Development and use of FRAX® in osteoporosis", Osteoporos int, 21(2), pp.407~413 (2010)
- McCloskey EV, "A meta analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX", J Bone Miner Res, 31(5), pp.940~948 (2016)
- "Osteoporosis treatment" (2018)[URL]
- Cohen A, "Osteoporosis after solid organ and bone marrow transplantation", Osteoporos Int, 14(8), pp.617~630 (2003)
- Camacho PM, "American association of clinical endocrinologists and american college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2016", Endocr Pract, 22(Suppl 4), pp.1~42 (2016)
- Young AL, "Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection : 5-year experience", Eye, 16(3), pp.304~308 (2002)
- Naylor KL, "FRAX predicts fracture risk in kidney transplant recipients", Transplantation, 97(9), pp.940~945 (2014)
- 박소영, "Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis", 대한골대사학회지, 25(4), pp.195~211 (2018), 대한골대사학회
- Lucey MR, "Long term management of the successful adult liver transplant : 2012 practice guideline by the american association for the study of liver diseases and the american society of transplantation", Liver Transpl, 19(1), pp.3~26 (2013)
- Sullivan SD, "Age of menopause and fracture risk in post-menopausal women randomized to calcium+vitamin D, hormone therapy, or the combination: results from the womens health initiative clinical trials", Menopause, 24(4), pp.371~378 (2017)
- Vestergaard P, "Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis", Osteoporos int, 18(4), pp.427~444 (2007)
- Jung JW, "The characteristics and treatment of bone loss after liver transplant", J Korean Soc Transplant, 25(4), pp.249~256 (2011)
- Brunova J, "Osteoporosis therapy with denosumab in organ transplant recipients", Front Endocrinol(Lausanne), 9, pp.162~ (2018)
- Mok CC, "Switching of oral bisphosphonates to denosumab in chronic glucocorticoid users : a 12-month randomized controlled trial", Bone, 75, pp.222~228 (2015)