Bone mass and body composition in children with chronic cholestasis before and after liver transplantation

Abstract

OSTEOPENIA is a common complication in chronic cholestatic liver diseases, and a number of reports have described various degrees of osteopenia, with or without fracture, in adults and children. It is not known if this bone disease is a result of a deficiency in vitamin D, minerals, or hormones, or whether it reflects the malnutrition that accompanies cholestatic diseases. Orthotopic liver transplantation (OLT) is often the only chance of recovery, but is itself known to cause a reduction in bone mineral content in adult patients. The decrease in bone mass occurs during the first 6 months following OLT and then a steady increase is observed after 1 year, and, as might be expected, most pathologic fractures occur within 6 months after OLT and their incidence decreases after 1 year. The causes of the bone loss observed during the first months after OLT are still debated, but the administration of steroids and immunosuppressive drugs may play a role. Little is known about the effect of OLT on bone mass in infants and children. The bone mineral content of children with chronic cholestasis diseases normalizes within a few months of transplantation. To our knowledge, no data are available concerning body composition in infants and children with cholestatic diseases before and after OLT, and thus we used dual-energy X-ray photon absorptiometry (DXA) measurements of total bone mass and body composition to monitor the posttransplantation growth of such patients.