Multiple vertebral fractures in a liver transplant recipient with HCV cirrhosis: A case report

Osteoporosis is a common, under-diagnosed and poorly treated complication of liver cirrhosis. The prevalence of osteoporosis in patients awaiting liver transplantation ranges from 12 to 55% and the prevalence of fractures is up to 22%, depending on the etiology of cirrhosis, the degree of liver insufficiency and the presence of additional predisposing factors, such as chronic cholestasis or use of corticoids. Overall, the fracture risk is estimated as double in cirrhotic patients compared to healthy individuals. In patients that undergo orthotopic liver transplantation (OLT), the pre-existing osteoporosis aggravates, mainly due to the immunosuppressive treatment with glucocorticoids and calcineurin inhibitors. The prevalence of bone disease after liver transplantations reaches 25% , and 15-30% of liver transplant recipients develop fractures shortly after the OLT, mainly vertebral ones. Improved survival rates of transplanted patients and the increased number of transplantations performed nowadays, have turned osteoporosis and its complications into an important cause of morbidity and mortality among this population.