An osteoporosis medication may be beneficial to people who experience bone loss following a liver transplant. The drug, alendronate, marketed as Fosamax, was tested in a clinical trial in Austria, whose findings were published in the journal Liver Transplantation this month.1
A Common Postoperative Side Effect
Osteoporosis is a common bone disease in which bones become thinner and more porous. It happens when the body fails to form new bone, and affects both men and women.2
While it can occur over the course of many years in most people, bone loss is also common in people who have end-stage liver disease, and can often be worsened by the immune-suppressing drugs that are given following a liver transplant, according to the investigators in this study from the department of Gastroenterology and Hepatology at Innsbruck Medical University in Austria. Some of the causes of osteoporosis in people with liver disease may include malnutrition, common immobility, and a vitamin D deficiency, they wrote.
"The need for therapy of transplantation-related bone loss has been recognized, but no guidelines based on controlled clinical trials dealing with larger cohorts of liver transplant recipients are yet available," wrote the study's lead investigator, hepatologist Gunda Millonig, MD, and her colleagues.
Previous reports in the medical literature suggested that Fosamax effectively treated postmenopausal women with osteoporosis,3 as well as osteoporosis caused by steroid use.4 Those positive findings prompted the latest trial.
Bone Loss Was Slowed
To clarify whether this type of treatment will work, Millonig's team tested the safety and efficacy of Fosamax in a group of 136 patients on a liver transplant waiting list between 1999 and 2003. In assessing bone health before surgery, Millonig and her colleagues found that those with end-stage liver disease also tended to have thinner bones more often. Further, just 28 percent of the patients had normal bone mineral density.
All patients were given doses of calcium and vitamin D once per day both before and after their transplant procedures, which was continued until the end of the study several years later. The patients who had been diagnosed with either osteopenia (a precursor to osteoporosis) or osteoporosis before surgery were then given Fosamax following their transplants. Patients whose bone mineral density dwindled after surgery also received the drug. In all, 98 patients were given the medication.
By the time the study ended, about two years following the transplant procedures, three-quarters of the patients who had taken Fosamax maintained constant levels of bone mineral density, while about one-fifth (26 patients) gained bone mineral density, "moving to the superior category," Millonig and her colleagues reported. Just eight of them had significantly thinner bones after taking the therapy.
When the study team looked at the number of bone fractures among the patients, 15 had them before surgery, whereas the risk of fracture was very low (about 6%) following the transplant.
"The striking result of this study was that alendronate combined with calcium and vitamin D almost completely prevented further bone loss in the first four months after liver transplant," the study team reported. "This is a significant improvement compared to the natural course of bone loss within the first few months after liver transplant, as reported in numerous publications."
Some Patients Gained Bone
Those patients who received the combination therapy and who had stable bone mineral density immediately following their transplants gained bone density over the next three years, the research team found, though for the most part, their bones never regained levels considered normal.
Based on what they discovered, Milonig and her colleagues claim Fosamax may be a treatment that could be beneficial for liver transplant patients who experience bone loss following their procedures. "However, these results can only be interpreted as hypothesis-generating for the present time, and further randomized studies are needed," they wrote.
1. Millonig G, Graziadei IW, Eichler D et al. Alendronate in combination with calcium and vitamin D prevents bone loss after orthotopic liver transplantation: A prospective single-center study. Liver Transpl 2005 Aug;11(8):960-6.
2. American College of Physicians. Health Care Topics: Osteoporosis. Available at: http://www.doctorsforadults.com/topics/dfa_oste.htm. Accessed August 17, 2005.
3. Hosking D, Chilvers CE, Christiansen C et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group. N Engl J Med 1998 Feb 19;338(8):485-92.
4. Saag KG, Emkey R, Schnitzer TJ et al. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med 1998 Jul 30;339(5):292-99.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
