Pitfalls in the interpretation of bone turnover markers in liver transplantation

Charlotte Krol; Desi Meiland; Olaf Dekkers; Eveline van der Veer; Herman Kroon; Ton Rabelink; Bart van Hoek; Neveen Hamdy

doi:10.1530/endoabs.37.EP226

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Endocrine Abstracts (2015) 37 EP226 | DOI: 10.1530/endoabs.37.EP226

ECE2015 Eposter Presentations Calcium and Vitamin D metabolism (96 abstracts)

Pitfalls in the interpretation of bone turnover markers in liver transplantation

Charlotte Krol ¹ , Desi Meiland ¹ , Olaf Dekkers ¹ , Eveline van der Veer ² , Herman Kroon ¹ , Ton Rabelink ¹ , Bart van Hoek ¹ & Neveen Hamdy ¹

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¹Leiden University Medical Centre, Leiden, The Netherlands; ²Groningen University Medical Centre, Groningen, The Netherlands.

Introduction: Osteoporosis and fractures are common in liver disease and fracture incidence increases after orthotopic liver transplantation (OLT). The value of bone turnover markers (BMTs) in the prediction of bone loss and fracture risk pre- and post-OLT is not known.

Study design: The BMTs P1NP, osteocalcin, BALP and CTX were measured initially or in Biobank stored sera at screening and at 3, 6 and 12 months post-OLT in consecutive OLT recipients between 2008 and 2011. A prerequisite was the availability of BMD data and of spinal radiographs at screening and 6 and 12 months post-OLT.

Results: 51 patients (80% male, median age 59 years) were included. Most common liver pathology was alcoholic (41%) and viral liver disease (26%). At screening, osteoporosis and osteopenia were prevalent in respectively 16 and 33% at the lumbar spine (LS) and 4 and 44% at the femoral neck (FN), and vertebral fractures were prevalent in 67%. Post-OLT, LS BMD remained stable but FN BMD decreased and 43% of patients developed new fractures. At screening, P1NP and CTX levels were high and osteocalcin levels low, but only CTX levels were predictive for bone loss and fracture risk. An increase in BALP at 6 month post-OLT was predictive for fracture risk a year post-OLT.

Conclusion: Despite the many pitfalls in the interpretation of particularly collagen-derived BTMs in liver disease, high CTX levels pre- OLT and an increase in BALP post-OLT were respectively predictive for bone loss and fracture risk during the first post-OLT year.