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JRPMS Vol 3, No 2, June 2019, p.52-59

doi: 10.22540/JRPMS-03-052


Case Report

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

Elpida E. Ntofi1, Symeon T. Tournis2

  1. First Dept of Internal Medicine, Konstantopouleio General Hospital of Nea Ionia, Athens, Post-Graduate Programme of Metabolic Bone Diseases, National and Kapodistrian University of Athens, Medical School
  2. Laboratory for the Research of Musculoskeletal System (LRMS) Medical School, University of Athens, KAT Hospital, Kifissia, Greece

Keywords: HCV cirrhosis, Orthotopic liver transplantation, Osteoporosis, Multiple vertebral fractures, Zolendronic acid


Cirrhosis is a known major risk factor for osteoporosis. The already compromised bone health of cirrhotic patients tends to deteriorate further after liver transplantation, mainly as a result of immunosuppressive treatment. This case report describes a 63-year-old man who presented with multiple vertebral fractures and severe osteoporosis, one year after orthotopic liver transplantation (OLT) because of end-stage HCV cirrhosis. At his initial consultation, the patient was taking everolimus and mycophenolate, while previously the immunosuppressive regimen included corticosteroids. We present follow-up data of the patient after anti-osteoporotic treatment, including consecutive measurements of bone mineral density, vertebral morphometry, biomarkers of bone turnover and related hormones. Two years after OLT, during which he followed treatment with calcium, vitamin D supplements and zolendronic acid (intravenous infusion of 5mg once a year), the patient showed remarkable improvement in bone densitometry, hormones and biomarkers of bone metabolism, with the exception of persistent secondary hyperparathyroidism. As the survival rates of liver transplant recipients improve, osteoporosis constitutes an important long-term complication among these patients. Consequently, prompt diagnosis and treatment of osteoporosis in cirrhotic and liver transplanted patients is crucial, with biphosphonates, and in particular zolendronic acid, a potent possible first-line therapeutical option.