肝移植术后的骨质疏松诊断和治疗

Diagnosis and treatment of osteoporosis after liver transplantation

肝移植是目前较为成熟的器官移植技术,随着肝移植和术后免疫抑制技术的不断发展,肝移植患者的术后生存率得到很大提升。总体而言,肝移植手术后患者生存质量良好,但近来研究发现肝移植患者术后骨质疏松症和骨折发生率显著增加。术后患者骨质疏松的发生主要与肝移植前存在的骨量减少和术后的骨量的大量丢失有关。所有肝移植患者均应进行骨质量评估,优选在移植前期或移植后早期进行,建议所有患者进行骨密度测量,并应包括可能导致骨病的代谢因素,评估骨折风险,并据此进行肝移植的骨病管理。本综述讨论了肝移植后的骨密度变化和骨折发生率,肝移植前后导致骨质疏松的因素以及对骨质疏松的管理。

Liver transplantation is a relatively mature organ transplantation technique. With the continuous development of liver transplantation and postoperative immunosuppressive technology, the postoperative survival rate of liver transplantation patients has been greatly improved. Overall, the quality of life of patients after liver transplantation is good, but recent studies have found that the incidence of postoperative osteoporosis and fractures in liver transplant patients is significantly increased. The occurrence of osteoporosis in postoperative patients is mainly related to the reduction of bone content before liver transplantation and the massive loss of bone after surgery. All liver transplant patients should be evaluated, preferably in the pre-transplant period or early post-transplantation, and evaluation should include metabolic factors that may lead to bone disease. All patients are recommended to measure bone mineral density, assess fracture risk, and conduct osteopathic management after liver transplantation accordingly. This review discusses bone mineral density changes and fracture incidence after liver transplantation, factors of osteoporosis caused by liver disease and transplantation, and management of osteoporosis before and after liver transplantation.