1999: One-year Incidence of Clinical Fragility Fractures After Implementing an Osteoporosis Care Protocol in Patients Eligible for Liver Transplantation

Cristina Rodríguez-Alvear¹, Mª Carmen López-González², Elisabet Perea-Martínez³, Antonio Avilés-Hernández³, Irene Calabuig-Sais¹, Maria-Luisa Peral-Garrido⁴, Pilar Bernabeu-Gonzálvez³, Agustín Martínez-Sanchís¹, Joaquim Esteve-Vives³, PALOMA VELA⁵, Cayetano Miralles Maciá³, Vega Jovani⁶ and Mariano Andrés¹, ¹Dr Balmis Alicante General University Hospital-ISABIAL, Alicante, Spain, ²General University Hospital Dr. Balmis, Alacante, Spain, ³General University Hospital Dr. Balmis, Alicante, Spain, ⁴Vinalopó University Hospital, Novelda, Spain, ⁵Rheumatology, Hospital General Universitario Alicante, Alicante, Spain, ⁶Department of Rheumatology, Hospital General Universitario Dr. Balmis, Alicante, Spain

Background/Purpose: In solid organ transplantation, liver transplants are among those most frequently associated with the development of low bone mass, which occurs in up to 85% of patients. The estimated incidence of fractures in the post-transplant period, especially in the first six months, ranges from 17% to 65%. However, this can drop to as low as 3.5% after establishing a fracture prevention protocol. In 2019, our center developed an action plan for preventing osteoporotic fractures in the post-transplant period. In a previous report, we observed that 77.3% of liver transplant recipients were candidates to start anti-osteoporosis treatment at the baseline evaluation.
The aim is to estimate the incidence of clinical fragility fractures in patients included in the pre-liver transplant study one year after the baseline evaluation of their bone health.

Methods: In this prospective cohort study, the incidence of clinical fragility fractures was analyzed one year after a multidisciplinary pre-liver transplant assessment in a tertiary academic center in Spain. The study included patients who underwent an initial study from February 2019 to December 2021, underwent liver transplantation and had complete follow-up at one year. The indication for anti-osteoporotic treatment at baseline was defined as bone densitometry with a T SCORE value of less than −1, vertebral wedging assessed by X-ray, or fragility fracture. During the annual follow-up visits, patients were examined for clinical fragility fracture. This descriptive study shows the cumulative incidence at one year and its 95% confidence interval (CI).

Results: Of the 162 patients who underwent the initial evaluation, 79 (48.8%) received a liver transplant and had a full follow-up at one year. Three-quarters of the sample were men, with a mean age of 60 years (standard deviation [SD] 7.5) and a mean body mass index (BMI) of 28.24 kg/m² (SD 4.35). Most (73.4%) were smokers, and 67% were moderate or heavy drinkers. At baseline, 2.5% (n=2) presented a fragility fracture, and 7.6% (n=6) a vertebral fracture as assessed by X-ray. Half (50.6%, n=40) presented osteopenia, and 21.5% (n=17) osteoporosis. Anti-osteoporosis therapy was indicated in 74.7% (n=59) and administered in 69.7% (n=55), consisting of bisphosphonates (92.7%) or denosumab (7.3%). Of the total liver transplant recipients with follow-up at one year, 4 experienced a clinical fracture (cumulative incidence 5%, 95% CI 1.9-12.3%; Table 1).

Conclusion: After establishing a protocol for preventing fractures in patients who are candidates for liver transplantation, the rate of post-transplant fractures was lower than in the historical series and comparable to another series with pre-transplant care.




C. Rodríguez-Alvear: None; M. López-González: None; E. Perea-Martínez: None; A. Avilés-Hernández: None; I. Calabuig-Sais: None; M. Peral-Garrido: None; P. Bernabeu-Gonzálvez: None; A. Martínez-Sanchís: None; J. Esteve-Vives: None; P. VELA: AbbVie/Abbott, 5, AstraZeneca, 5, Eli Lilly, 5, 6, GlaxoSmithKlein(GSK), 6, Novartis, 5, Pfizer, 5; C. Miralles Maciá: None; V. Jovani: None; M. Andrés: None.