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      The impact of osteoporosis on health-related quality of life in patients after liver transplantation – a pilot study

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          Abstract

          Introduction

          Liver transplantation (LT) is now a well-established procedure with 5-year survival rates over 70%, and one of its ultimate goals is the improvement of patient health-related quality of life (HRQOL). Osteoporosis remains a serious potential complication of LT, leading to fragility fractures, pain, and functional impairment.

          Aim

          To assess the degree of osteoporosis and the impact of fragility fractures on HRQOL in patients with chronic liver diseases treated with LT.

          Material and methods

          Twenty-seven patients (14 female, 13 male) at a median period of 3.5 years post LT participated in the study. HRQOL was assessed by Short Form-36 and PBC-40 instruments. Bone mineral density (BMD) in the lumbar spine and hip neck were measured by dual-energy X-ray absorptiometry. Physical activity was assessed by questionnaire. Data on the duration of the liver disease, time from LT, and fragility fractures were also collected.

          Results

          As many as 74.1% of the patients had reduced BMD ( t-score < -1.0 SD) in the hip. Mean values of the spine and hip BMD z-scores were -1.1 and -0.9 SD, respectively. Time after LT, percentage of lean tissue, and physical activity were positively associated with BMD. The prevalence of fractures was 48%. We did not find significant differences in age, gender, body composition parameters, physical activity, BMD, and HRQOL scores between the subjects with and without fractures.

          Conclusions

          We found a high prevalence of fragility fractures and a decreased BMD in LT recipients. Patients with a history of fractures had similar HRQOL scores to those without fractures.

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          Most cited references36

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          The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.

          This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years; data are presented on the performance of the instrument in 15 different settings worldwide.
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            Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.

            (1993)
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              Quality of life in patients with osteoporosis.

              Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)-independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.
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                Author and article information

                Journal
                Prz Gastroenterol
                Prz Gastroenterol
                PG
                Przegla̜d Gastroenterologiczny
                Termedia Publishing House
                1895-5770
                1897-4317
                19 June 2015
                2015
                : 10
                : 4
                : 215-221
                Affiliations
                [1 ]Hepatology and Internal Medicine Unit, Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
                [2 ]Liver Research Laboratories, Pomeranian Medical University, Szczecin, Poland
                [3 ]Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
                [4 ]Department of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
                [5 ]Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
                Author notes
                Address for correspondence: Prof. Tomasz Miazgowski MD, PhD, Department of Hypertension and Internal Medicine, Pomeranian Medical University, 1 Unii Lubelskiej St, 71-252 Szczecin, Poland. phone: +48 91 425 35 50, fax: +48 91 425 35 52. e-mail: miazgowski@ 123456interia.pl
                Article
                25298
                10.5114/pg.2015.52343
                4697035
                03ffc185-3a08-4c89-b70e-bda23263771a
                Copyright © 2015 Termedia

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 November 2014
                : 12 December 2014
                : 06 January 2015
                Categories
                Original Paper

                liver transplantation,osteoporosis
                liver transplantation, osteoporosis

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