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.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/one-year-incidence-of-clinical-fragility-fractures-after-implementing-an-osteoporosis-care-protocol-in-patients-eligible-for-liver-transplantation/