Bronwyn A.L. Crawford, MBBS, PhD; Cherie Kam, MPH, GDipScMed; Julie Pavlovic, RN; Karen Byth, PhD, DIC, CStat RSS; David J. Handelsman, MBBS, PhD; Peter W. Angus, MBBS, MD; Geoffrey W. McCaughan, MBBS, PhD
Clinicaltrials.gov Identifier: NCT00114556.
Acknowledgments: The authors thank Dr. Sally Duke for data management.
Grant Support: Novartis Pharmaceuticals Pty Ltd. supplied zoledronic acid and some financial support.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Geoffrey W. McCaughan, MBBS, PhD, Liver Unit E9, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
Current Author Addresses: Dr. Crawford: Department of Endocrinology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
Ms. Kam: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales 2052, Australia.
Ms. Pavlovic and Professor Angus: Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria 3084, Australia.
Dr. Byth: NHMRC Clinical Trials Centre, University of Sydney, Mallett Street, Camperdown, New South Wales 2050, Australia.
Professor Handelsman: Department of Andrology, Concord Hospital, University of Sydney, ANZAC Research Institute, Sydney, New South Wales 2139, Australia.
Professor McCaughan: The AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
Author Contributions: Conception and design: B.A.L. Crawford, D.J. Handelsman, G.W. McCaughan.
Analysis and interpretation of the data: B.A.L. Crawford, K. Byth, D.J. Handelsman, G.W. McCaughan.
Drafting of the article: B.A.L. Crawford, D.J. Handelsman, P.W. Angus, G.W. McCaughan.
Critical revision of the article for important intellectual content: B.A.L. Crawford, K. Byth, D.J. Handelsman, P.W. Angus, G.W. McCaughan.
Final approval of the article: B.A.L. Crawford, D.J. Handelsman, P.W. Angus, G.W. McCaughan.
Provision of study materials or patients: P.W. Angus, G.W. McCaughan.
Statistical expertise: K. Byth, D.J. Handelsman.
Obtaining of funding: G.W. McCaughan.
Administrative, technical, or logistic support: C. Kam, J. Pavlovic, G.W. McCaughan.
Collection and assembly of data: B.A.L. Crawford, C. Kam, J. Pavlovic.
Crawford B., Kam C., Pavlovic J., Byth K., Handelsman D., Angus P., McCaughan G.; Zoledronic Acid Prevents Bone Loss after Liver Transplantation: A Randomized, Double-Blind, Placebo-Controlled Trial. Ann Intern Med. 2006;144:239-248. doi: 10.7326/0003-4819-144-4-200602210-00005
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Published: Ann Intern Med. 2006;144(4):239-248.
Osteoporosis is a frequent complication of end-stage liver disease of various causes. Initially described in patients with cholestatic liver disease (1-4), it also occurs in association with cirrhosis secondary to hepatitis B and C virus infection and alcohol abuse (5-8). Although contributing factors that are common to postmenopausal osteoporosis have been identified, such as age, gonadal status, and vitamin D deficiency, cirrhosis is an independent risk factor for osteoporosis (8, 9). Some patients with cirrhosis eventually need liver transplantation, a procedure that is associated with accelerated bone loss, particularly within the first 3 to 6 months (10-13). Investigators report fractures rates of 16% to 40% during this period, predominantly of the vertebrae and ribs (12-16). Pain and restricted mobility after a fracture delay rehabilitation of patients and are severe enough at times to require hospitalization.
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Endocrine and Metabolism, Gastroenterology/Hepatology, Metabolic Bone Disorders, Liver Transplantation, Liver Disease.
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