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  DDW Liver Conference
San Francisco, May 19-22, 2002
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Reported by Jules Levin
  A percentage of person with HIV are suffering bone loss, osteopenia & posteporosis. Much research on this has been conducted and can be found on the NATAP website. Persons with HCV also have bone loss. And several comprehensive articles on this can be found by using the NATAP website search engine or trying the Lipodystrophy section on the site. At DDW researchers from the Mayo Clinic presented an oral talk about the prevalence of bone loss in HCV. Below is a description of their study. HCV therapy that cleared HCV viral load may reverse the bone loss issue because the problem may be due to the presence of virus. Persons coinfected with HIV and HCV face a potential double hit on bone loss. It is particularly important to consider improving diet, calcium supplementation, weight bearing exercise, and reducing cofactors that may increase risk for bone loss. The articles on the NATAP website discuss extensively all the potential cofactors which include smoking cigarettes, coritcosteroids (from PCP prophylaxis) and a number of others.
This study looked at 207 patients transplanted at the Mayo Clinic. Follow-up was for as long as 12 months. There were 68 patients with HCV; they were on average 54 years of age, 49% male. 11% were using calcium and 5% Vitamin D. A percentage of them were smokers. Before transplant 37% had osteopenia and 28% osteoporosis. After 12 months follow-up about the same percentage had osteoporosis. The fracture rate was 8.8% before transplant and 16% 12 months after transplant. 80% of the fractures were spinal. The authors concluded 66% of patients with End Stage Liver Disease related to HCV have osteopenic bone disease prior to liver transplant.
Elizabeth Carey, Vijayan Balan, Walter K. Kremers, J E. Hay, Phoenix, AZ; Rochester, MN
BACKGROUND: The increased prevalence of osteoporosis in patients with cholestatic liver diseases is well established. The prevalence of metabolic bone disease in end stage liver disease (ESLD) due to viral etiologies is not well known. In a recent small study, we found that patients with ESLD due to hepatitis C (HCV) in combination with alcohol had higher rates of osteoporosis (T-score<-2.5) (53%) than patients with ESLD related to HCV alone (23%) or alcoholic liver disease alone (37%) (Yousfi, Hepatology 2001;34:A232).
AIMS: 1) To compare the prevalence of osteopenia in patients with ESLD secondary to HCV, Alcoholic liver disease (ALD), and HCV+ALD, 2) to determine the effect of orthotopic liver transplantation (OLT) on bone density in these groups, and 3) to determine fracture rates before and after OLT.
METHODS: From 1991 to present, all patients transplanted at Mayo Rochester for HCV, ALD, or HCV+ALD were followed pretransplant, at 4 months and 12 months after OLT. All patients were followed clinically, biochemically, radiologically and by measurements of Bone Mineral Density (BMD).
RESULTS: Pretransplant demographics and T scores of lumbar spine before and after OLT are summarized in the table below. Baseline mean T-score was lower in the HCV group than in the ALD group (p=0.048). All groups showed a T-score nadir at 4mo post-OLT with mild improvement at 12mo post-OLT. The ALD group sustained the highest fracture rate (ALD: 19.7%, HCV: 14.7%, HCV+ALD: 16.4%). Most (88%) were vertebral compression fractures.
CONCLUSIONS: Patients with advanced HCV have lower BMD than those with ALD or HCV+ALD, despite more advanced liver disease in the ALD group. Fractures were not uncommon in the first post-operative year in patients transplanted for HCV and ALD. As with cholestatic liver disease, osteopenia and fractures must be considered in the management of patients with advanced hepatitis C and advanced alcoholic liver disease especially in the setting of liver transplantation.