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BONE MINERAL DENSITY IN CHILDREN WITH CHOLESTATIC LIVER DISEASE PRE-AND-POST LIVER TRASPLANTATION
W Aldekhail1, D Mager2, D Jackshaw2, J Dypchney2, S Gilmour1
1Division of Pediatric Gastroenterology Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Canada; 2Department of Agriculture, Food and Nutrition Science, University of Alberta, Edmonton
Objectives: Metabolic bone disease is considered to be prevalent in children with chronic cholestatic liver disease: pre and post liver transplantation. The purpose of this study was to determine if bone mineral density is reduced in this population and to assess the potential variables (anthropometric, disease severity, bone age, bone surface area) contributing to decreased bone mineral density.
METHODS: We conducted a retrospective chart review (n=58) of children clinically diagnosed with mild to moderate chronic cholestatic (MCC) liver disease pre- and post liver transplantation. (February 1999-December 2006) Bone mineral density (BMD) and bone mineral content (BMC) was measured using Dual Energy X-ray Absorptiometry (DEXA).
RESULTS: 18 children with MCC liver disease (7.4 ± 4.4 yrs; range 0.5-14.8 yrs) and 40 children post liver transplantation (7.5 ± 3.1 yrs; range 2.25-15.25 yrs) were reviewed. There were no significant differences in anthropometric variables between the two groups (p>0.05). Children with MCC liver disease had significantly lower lumbar BMD z-scores (–1.53 ± 0.81) when compared to children post liver transplantation (–0.68 ± 1.03) (p<0.05), indicative of a high prevalence of osteopenia in this population (77% pre transplant, 36% post transplant)
CONCLUSIONS: Osteoporosis and osteopenia are common forms of bone disease found in children with chronic liver disease pre- and post liver transplantation, and are associated with pathologic fractures, decreased quality of life, and increased mortality in these patients. Routine evaluation of bone mineral density pre and post transplantation is critical to aid in prevention of bone disease in children with chronic liver disease and to avoid these serious complications.