A Systematic Review and Meta-Analysis on the Incidence of Osteoporosis and Fractures after Liver Transplant.

AIM Following liver transplant (LT), osteoporosis is a severe complication that causes morbidity. However, the incidence and risk factors of osteoporosis and fractures have not been well described. METHODS Single-arm meta-analysis of studies reporting osteopenia, osteoporosis and fractures post-LT was performed with meta regression for study period. Dichotomous variables, continuous variables and time-to-event variables were pooled in odds ratio, weighted mean difference and hazard ratio respectively. For risk factors with limited data, a systematic review of literature was conducted. RESULTS There was a significant increase in both osteoporosis and fractures compared to non-LT patients. Osteopenia, osteoporosis and incident fractures were newly diagnosed in 34.53% (CI: 0.17 - 0.56, n=301), 11.68% (CI: 0.05 - 0.24, n=1251) and 20.40% (CI: 0.13 - 0.30, n=4322) of LT patients respectively. Female gender (p=0.017) increased risks of osteoporosis but not older age and BMI. Older age, lower pre-LT bone mineral density (BMD), presence of bone disease pre-LT were significant risk factors for fractures but not female gender, post-menopausal state, BMI, smoking and alcohol. CONCLUSION There is a high incidence of skeletal complications post LT. Older age, lower pre-LT BMD and presence of bone disease pre-LT are significant risk factors that are associated with incident fractures in liver transplant recipients.