PHILADELPHIA — Prophylactic zoledronic acid appears to reduce morbidity associated with bone mineral loss and fractures in patients who have undergone a liver transplant, Dr. Martin Bodingbauer said at the annual meeting of the American Society for Bone and Mineral Research.
Vertebral fractures after liver transplant are linked to substantial morbidity and increased mortality. Fracture rates in the first 12 months after the procedure have been reported to range from 25% to 35%.
“Bone mineral density measurements do not accurately predict the fracture risk of the transplant patients,” said Dr. Bodingbauer of the surgery department at the Medical University of Vienna. The etiology of hepatic osteodystrophy is unclear.
In this preliminary study, 96 patients were randomized at the time of transplant to receive treatment with zoledronic acid (eight 4-mg IV infusions in 12 months) along with calcium (1,000 mg/day) and vitamin D (800 IU/day) supplements, or supplements alone.
Of the 96 patients, 47 were randomized to the treatment group and 49 to the control group. Results at 24 months' follow-up were available for 35 patients in the treatment group and 34 control subjects.
At 24 months, 26% of the treatment group and 46% of the control group either had a fracture or had died—the combined primary end point. The difference between the groups was statistically significant.
Analysis of bone biochemical markers indicated a statistically significant lower rate of bone turnover in the treated patients than in the control group.
In addition, bone mineral density measurements were greater in the treatment patients than in the control subjects.
Eight deaths occurred in the treatment group and 12 among the control subjects—all due to either septicemia or posttransplantation proliferative disorder.
Infection and nausea occurred at similar rates in each group, and both side effects resolved quickly. There were seven discontinuations in each group, mostly due to liver or kidney dysfunction.
Dr. Bodingbauer disclosed that he had no conflicts of interest.
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