Monday July 02, 2018 from 09:45 to 11:15
Predictive Factors Analysis of Osteoporosis and Fragility Fractures After Liver Transplantation
Shuji Akimoto1, Hiroyuki Tahara1, Das Lalit Kumar1, Yuki Imaoka1, Naruhiko Honmyo1, Ikki Nakashima1, Kazuhiro Taguchi1, Asuka Tanaka1, Ryosuke Nakano1, Jamilya Saparbay1, Nobuki Ishida1, Senichiro Yanagawa1, Hiroshi Sakai1, Seiichi Shimizu1, Masahiro Ohira1, Kentaro Ide1, Tsuyoshi Kobayashi1, Yuka Tanaka1, Hideki Ohdan1.
1Gastroenterological and Transplant Surgery, Hirosihma University, Hiroshima, Japan
In liver transplant recipients, a fragility fracture caused by osteoporosis due to administration of immunosuppressive agents and aging leads to a decrease in ADL. The recipients with the fragility fracture exhibit sometimes poor prognosis. We analyzed predictive factors of the postoperative fragility fracture and osteoporosis in 247 liver transplant recipients in our department. Lumbar spine T score and young adult mean (YAM), which are criteria for osteoporosis diagnosis, were calculated in 45 patients who measured postoperative bone mineral density (BMD). The incidence in the postoperative fragility fracture between both groups with and without osteoporosis was significantly different, 88.2 vs 14.3% (p<0.0001). There were no significant difference in bone metabolism marker abnormality (serum Ca, P, iPTH), sex, presence or absence of menopause, BMI, hepatic viral primary disease and administration duration of steroid or diuretics between both groups with and without osteoporosis. However, the incidence of osteoporosis in alcoholic cirrhosis groups was significantly higher than that in non-alcoholic groups, 23.5 vs 3.8% (p=0.039). In addition, single nucleotide polymorphisms (SNP) of vitamin D receptor (VDR; Fok 1, Apa 1, Bsm 1, Taq 1) related to bone metabolism were analyzed in the 141 recipients. 88.9% of cases with osteoporosis was VDR (Bsm 1) bb genotype, whereas 55.6% of cases without osteoporosis was bb genotype (p = 0.0495). In addition, the population of VDR (Taq 1) TT genotype in the group with the fragility fracture was significant lower than that in the no fracture group (p = 0.0114). These results suggest that presence of alcoholic cirrhosis and the VDR (Bsm1) bb genotype group may be a predictive factor of osteoporosis development. Analysis of SNPs of VDR might be useful for risk assessment of osteoporosis and earlier therapeutic intervention.