Oral

Background:
Patients with chronic liver disease (CLD) risk developing bone fractures from hepatic osteodystrophy. Despite liver transplantation (LT), they are still at risk of bone fractures due to the long-term use of immunosuppressive drugs, which could affect bone health. Data on the prevalence of vertebral fracture (VF) in children with CLD is limited.

Objectives:
To evaluate the prevalence of VF and associated factors in children with CLD with and without LT.

Study design:
Cross-sectional study

Methods:
Patients aged 3-21 years with CLD, before and after LT, were included. A lateral thoracolumbar spine radiograph was obtained and assessed for VF using Mäkitie’s method. Clinical and biochemical data and symptoms of back pain were collected. Factors associated with VF were evaluated in both non-LT and LT groups.

Results:
A total of 147 patients (80 female; mean age 9.50 + 4.36 years) were enrolled. Thirty-seven (25.2%) were non-LT group and 110 (74.8%) were LT group. Biliary atresia was the most common cause of CLD (87.1%). VFs were identified in 21 patients (14.3%) including 4 (10.8%) in the non-LT and 17 (15.5%) in the LT groups. Eighteen (85.7%) patients with VF reported no history of back pain. Overall, patients with VF had a lower height z score (p=.021) and more frequent hepatopulmonary syndrome (p=.003) than those without VF. In the LT group, lower height z score, hepatopulmonary syndrome, higher serum bilirubin levels, and history of vitamin D deficiency after 1-year following LT were associated with VF in univariate analysis. However, no risk factors for VF were revealed in multivariate analysis. By ROC analysis, a height z score below -1.8 had a sensitivity of 52.9% and specificity of 76.3% in detecting VF in the LT group.

Conclusion:
Overall prevalence of VF in this cohort was 14.3%, and most patients were asymptomatic. After LT, children with CLD were still at increased risk for VF, with the prevalence close to those without LT. Routine screening for VF should be considered in post-LT CLD children with a height z score below -1.8.