BackgroundBone metabolism abnormalities observed in liver cirrhosis are refered to as hepatic osteodystrophy. Osteodystrophy consists of osteoporosis and or osteomalacia1,2. Our study investigated the prevalence of osteoporosis in fifty patients with liver cirrhosis and searched determinant factors of bone loss.MethodsFifty patients (29 females and 21 males, mean age 55 years) with liver cirrhosis were enrolled in this study. The bone mineral density (BMD) was evaluated by dual energy x ray absorptiometry of the lumbar spine (L1-L4) and total hip. A detailed questionnaire was used to assess: risk factors of osteoporosis and characteristics of the cirrhotic disease (such as etiology, child-pugh stage, complications, meld score and blood samples…). Univariate analysis was used to determine correlation with low BMD.ResultsA low BMD was finding in 37 patients (74%), 25 females and 12 males. Osteoporosis (TScore≤-2,5) was noted in 20 (40%) and osteopenia (-2.5 < TScore ≤ -1) in 17 (34%) patients. Mean BMD was 0.980±0.17g/cm2 in lumbar spine and 0.900±0.32g/cm2 in total hip. Ten patients have sustained osteoporotic fracture. Etiology of cirrhosis was chronic viral hepatitis (48%), primary biliary cirrhosis (20%), primary sclerosing cholangitis (6%) and autoimmune hepatitis (4%). The cause was indeterminate in 10% of patients. In univariate analysis, a positive correlation with low BMD was noted with an age≥50 years (p=0.021), female sex (p=0.021), previous osteoporotic fracture (p=0.034), more than two complications of the cirrhotic disease (p=0.024), child-pugh stage B and C (p=0.006) and low albumin level (p=0.02).ConclusionsThe prevalence of osteoporosis in our study (40%) is concordant with literature data (20 to 56%)3,4. Determinant factors of low body mass were an age≥50, female sex, previous osteoporotic fracture, more than two complications of the cirrhotic disease, child-pugh stage B and C and low albumin level. The limits of our study were mainly the low effectif and the absence of a control group.ReferencesLong RG, Meinhard E, Skinner RK, Varghese Z, Wills MR, Sherlock S. Clinical, biochemical, and histological studies of osteomalacia, osteoporosis, and parathyroid function in chronic liver disease. Gut 1978:19(2):85-90.Long RG, Wills MR. Hepatic osteodystrophy. Br J Hosp Med. 1978; 20(3):312-21.Goral V, Simsek M, Mete N. hepatic ostéodystrophie and liver cirrhosis. World J Gastroenterol 2010; 16:1639-1643.German Lopez-Larramona, Alfredo J Lucendo, Sonia Gonzalez-Castillo, Jose M Tenias. Hepatic ostéodystrophie: An important matter for consideration in chronic liver disease. World J Hepatol 2011; 3 (12):300-307.Disclosure of InterestNone declared
