Bone disease

Liver disease produces clinically significant bone abnormalities in some recipients. Recipients with primary biliary cirrhosis have been most extensively studied both before and after liver transplantation, but other patients with liver disease may have similar problems. These patient have significant problems with demineralization of axial and long bones. Problems may range from back pain due to compression fractures of the vertebral column to fractures of long bones. Following liver transplantation the bone density continues to fall, reaching a nadir at six months following transplantation. It is at this point, that patients are most prone to symptoms and/or fractures. A lumbar spine film will document compression fractures and marked demineralization. Without radicular or nerve compression symptoms, no further investigation is needed. Treatment is conservative with a back brace for comfort and pain medication such as Vicodin. Very severe pain may respond to nerve blocks or epidural anesthesia. With severe symptoms increased calcium supplements may be recommended to increase the rate of mineralization of the bones. The vast majority of patients' symptoms stop within a year and are usually self-limited. During this first year following transplantation consultation with an orthopedic surgeon or endocrinologist may be necessary in this group of patients.