Alendronate有助于预防肝脏移植的骨质流失

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作者：Laurie Barclay, MD
出处：WebMD医学新闻
审阅：Gary D. Vogin, MD

　　July 26, 2005 - 肝脏移植期刊八月份刊载，一项先期性、单临床中心的研究结果显示，Alendronate可以预防肝脏移植(LT)引起的骨质流失。
　　
　　奥地利Innsbruck医学大学的Gunda Millonig医师表示，骨质流失是肝脏移植前后常见的并发症；器官移植引发的骨质流失必须予以治疗，但是目前尚无医疗准则是根据多数的肝脏受赠者所进行对照式临床试验。
　　
　　本研究的目的在于确定bisphosphonate对于肝脏移植后的疗效，视其对于骨质流失的治疗效果，患者为末期肝病，等待肝脏移植者；肝移植之前，及4、12、24、36与48个月之后，所有的136位患者皆以双重X光吸收扫描作骨质密度及骨新陈代谢的测量；所有的患者皆接受维生素D与钙质补充，移植前患有骨质减少及骨质疏松症的患者，在移植之后同时接受alendronate治疗。
　　
　　移植之前，48.5%的患者患有骨质减少症，23.5%患有骨质疏松；移植前的骨质密度皆无关于性别，潜藏的肝病，或Child-Turcotte-Pugh等级；但是，身体质量指数在移植之前会明显关连到骨折的风险。
　　
　　对于骨质减少与骨质疏松的患者，Alendronate可以预防移植之后骨质的持续流失；肝脏移植后24个月内，Alendronate可以增加骨质疏松患者的身体质量指数。
　　
　　研究的限制因素，为即使同一位患者，骨质转换标记有著高度的变化，试验亦无随机分配。
　　
　　Millonig医师表示，根续研究结果，Alendronate可以有效的预防肝脏移植所产生的自然骨质流失；但是，这些结果目前只能视为理论性的，必须进行更进一步的随机分配试验。
　　
　　本研究的赞助单位，含Verein zur Forderung Wissenschaftlicher Arbeit in Gastroenterologie und Hepatologie der Universitat Innsbruck。

Alendronate May Help Prevent Bone Loss Associated With Liver Transplant

By Laurie Barclay, MD
Medscape Medical News

July 26, 2005 — Alendronate can prevent the bone loss associated with liver transplantation (LT), according to the results of a prospective, single center study reported in the August issue of Liver Transplantation.

"Bone loss is a common complication in patients before and after LT," write Gunda Millonig, MD, from Innsbruck Medical University in Austria, and colleagues. "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 LT recipients are yet available."

The study objective was to determine the efficacy of bisphosphonates after LT in preventing progressive bone loss in patients with end-stage liver diseases awaiting LT. All 136 patients had measurement of bone mineral density (BMD) by dual x-ray absorptiometry and markers of bone metabolism before and 4, 12, 24, 36, and 48 months after LT. Before and after LT, all patients received vitamin D and calcium supplementation, and those with osteopenia or osteoporosis before LT also received alendronate after LT.

Before LT, 48.5% of patients had osteopenia, and 23.5% had osteoporosis. Decreased BMD before LT was not associated with sex, underlying liver disease, or Child-Turcotte-Pugh classification. However, body mass index before LT was significantly correlated with fracture risk.

In patients with osteoporosis and osteopenia, alendronate prevented the consistently observed bone loss after LT. Within 24 months after LT, alendronate was also associated with increased BMD in patients with osteoporosis.

Study limitations include lack of randomization and high variability of bone turnover markers within the same individual.

"Our study suggests that alendronate is efficacious in preventing the natural course of bone loss associated with LT," the authors write. "However, these results can only be interpreted as hypothesis-generating for the present time, and further randomized studies are needed."

Verein zur F?rderung Wissenschaftlicher Arbeit in Gastroenterologie und Hepatologie der Universit?t Innsbruck supported this study.

Liver Transpl. 2005;11:960-966

Reviewed by Gary D. Vogin, MD

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