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A Systematic Review and Meta-Analysis on the Incidence of Osteoporosis and Fractures after Liver Transplant

Wen Hui Lim 1Cheng Han Ng 1Zachariah Gene Wing Ow 1Owen Tsung Wen Ho 1Phoebe Wen Li Tay 1Keng Lin Wong 1 2Eunice Xiang Xuan Tan 3 4Si Ying Tang 3 4Claire Min-Li Teo 5Mark D Muthiah 1 3 4

Transpl Int. 2021 Apr 9.doi: 10.1111/tri.13863. 


Aim: Following liver transplant (LT), osteoporosis is a severe complication that causes morbidity. However, the incidence and risk factors of osteoporosis and fractures have not been well described.

Methods: Single-arm meta-analysis of studies reporting osteopenia, osteoporosis and fractures post-LT was performed with meta regression for study period. Dichotomous variables, continuous variables and time-to-event variables were pooled in odds ratio, weighted mean difference and hazard ratio respectively. For risk factors with limited data, a systematic review of literature was conducted.

Results: There was a significant increase in both osteoporosis and fractures compared to non-LT patients. Osteopenia, osteoporosis and incident fractures were newly diagnosed in 34.53% (CI: 0.17 – 0.56, n=301), 11.68% (CI: 0.05 – 0.24, n=1251) and 20.40% (CI: 0.13 – 0.30, n=4322) of LT patients respectively. Female gender (p=0.017) increased risks of osteoporosis but not older age and BMI. Older age, lower pre-LT bone mineral density (BMD), presence of bone disease pre-LT were significant risk factors for fractures but not female gender, post-menopausal state, BMI, smoking and alcohol.

Conclusion: There is a high incidence of skeletal complications post LT. Older age, lower pre-LT BMD and presence of bone disease pre-LT are significant risk factors that are associated with incident fractures in liver transplant recipients.