Bone mineral density loss in patients with cirrhosis

Abstract

Background/Aims:Evidence of increased risk of osteoporosis and osteopenia in chronic liver disease and cirrhosis is inconsistent. This study aims to investigate this relationship and to identify the predictors of increased loss of bone mineral density in Saudi patients.Patients and Methods:One hundred and sixty-four patients and controls who are age and gender matched, were included in this study with 1:1 ratio. Patients' included in this study were adults with confirmed liver cirrhosis. Bone mineral densitometry (BMD) at both lumbar spine (LS) and femoral neck (FN) were collected for both groups. Univariate and multivariate regression analyses were performed to identify predictors of BMD loss.Results:Results showed that cirrhotic patients are at higher risk of developing osteoporosis or osteopenia at LS (OR 2.23, 95% CI [1.19–4.19], P = 0.01) but not at FN, when compared to control sample. Patients with cirrhosis were found to have lower vitamin D and PTH levels (P = 0.0005) and (P = 0.006), respectively. Of the possible predictors tested (gender, age, body mass index [BMI], phosphorus, calcium, parathyroid hormone (PTH), vitamin D, and Model for End Stage Liver Disease [MELD] score), female gender was the main predictor of loss of BMD at LS only (OR 4.80, 95% CI [1.47–15.73], P = 0.01).Conclusions:The study showed that cirrhotic patients are at increased susceptibility of having decreased BMD, particularly at the LS and it highlights the need for preventive measures, especially for female patients.

Bone mineral density loss in patients with cirrhosis

“…in SJG. [1] The authors found that cirrhotic patients are at increased risk of bone mineral density (BMD) loss at the lumber spine (LS) when compared to the general population. Out of the possible predictors tested (gender, age, body mass index, phosphorus, calcium, parathyroid hormone, vitamin D, and Model for End Stage Liver Disease [MELD] score), female gender was the main predictor of BMD loss at LS, highlighting the need for preventive measures especially for female patients.…”

“…Out of the possible predictors tested (gender, age, body mass index, phosphorus, calcium, parathyroid hormone, vitamin D, and Model for End Stage Liver Disease [MELD] score), female gender was the main predictor of BMD loss at LS, highlighting the need for preventive measures especially for female patients. [1] The authors noted that the study was limited by its retrospective nature, as a temporal relationship between cirrhosis and BMD loss could not be made. [1] Additionally, I believe that the following methodological limitation may limit the accuracy of the study results.…”

“…[1] The authors noted that the study was limited by its retrospective nature, as a temporal relationship between cirrhosis and BMD loss could not be made. [1] Additionally, I believe that the following methodological limitation may limit the accuracy of the study results. The authors mentioned that BMD was collected for both LS (L1–L4) and femoral neck (FN), and dual energy x-ray absorptiometry scan was used in measuring BMD.…”

“…From World Health Organization (WHO) criteria, the results were then classified according to T-score into normal: <–1 Standard Deviation (SD); osteopenia: between –1 and <–2.5 SD; and osteoporosis: >–2.5 SD at both LS and FN. [1] It is obvious that BMD reference values (BMDRVs) are additionally controlled by various determinants namely age, gender, weight, pubertal stage, ethnicity and socio-economic standard. [23] According to the aforementioned determinants, normative BMDRVs have been constructed for certain populations to be employed in the clinical field and research.…”

Bone mineral density loss in cirrhotics: Impact of country specific data

“…Clearly, as highlighted in our study, there is a need for larger prospective cohort studies to confirm this relationship. [2]…”