Common musculoskeletal disorders in chronic liver disease patients

Abstract

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

A Systematic Review and Meta-Analysis on Metabolic Bone Disease in Patients with Primary Sclerosing Cholangitis

“…The prevalence of osteoporosis in CCLD patients ranges from as low as 13% to as high as 95% [3,36]. A higher prevalence is reported in the Indian population, between 68 and 95% versus 13 and 70% in Western countries [12]. Bone turnover laboratory parameters showed noticeably increased levels of ALP and high bilirubin levels in PSC patients.…”

“…The prevalence of osteoporosis in patients with chronic liver disease was reported to be approximately 30% [11]. In addition, its prevalence was higher in patients with CCLD, and the prevalence of fractures was reported to be 7-35% [12]. Compared to the occurrence of osteoporosis accompanied by the low bone formation in primary biliary cholangitis (PBC), which has been reported frequently, this pattern is still unclear for PSC [13][14][15].…”

Hepatomusculoskeletal disorders: Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

“…It encompasses ailments of infectious (viral hepatitis) and non-infectious (alcohol abuse, non-alcoholic steatohepatitis, cancer) origin leading to progressive structural and functional depletion of hepatic physiology in the form of liver cirrhosis. CLD is associated with multisystem complications involving the kidneys, the heart, the nervous system and the musculoskeletal system[ 2 ]. Research in the field has recently sought hematological and electrocardiographic CLD biomarkers addressing CLD’s extrahepatic manifestations as a potential standpoint for the management of the disease and for the identification of novel therapeutic targets[ 3 - 5 ].…”

“…A search for relevant publications on Medline, Scopus and other databases reveals a plethora of terms used to describe CLD musculoskeletal implications. The wording is often alternating (musculoskeletal disorders in patients with CLD, hepatic osteodystrophy) and rather descriptive words addressing particular alterations associated with CLD (sarcopenia, osteosarcopenia, skeletal muscle mass) rather than the phenomenon as a whole[ 2 , 24 - 26 ]. A term grouping all of the aforementioned together has not been included in the Medical Subject Headings thesaurus and in the International Disease Classification (ICD10) system to date.…”

The effects of thymoquinone on steroid-induced femoral head osteonecrosis: An experimental study in rats

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Steroid-induced osteonecrosis (ON) of the femoral head represents one of the most significant complications of long-term high-dose steroid use. [1] Steroids are commonly used in the treatment of chronic autoimmune diseases such as systemic lupus erythematosus, nephrotic syndrome, asthma, after the organ transplantation, and in the patients hospitalized due to novel coronavirus disease-2019 (COVID-19). [2] The early diagnosis of ON of the femoral head (ONFH) is critical, since it mainly influences the young and middle-aged population, and progression of the disease to collapse of the femoral head occurs in most patients, if untreated.Although it has been argued that steroid-induced ON develops due to an ischemia in the bone, Objectives: In this study, we aimed to evaluate the antioxidant, antiapoptotic, osteoblastic and hypolipidemic effects of thymoquinone (TQ) treatment on the steroid-induced osteonecrosis of femoral head (ONFH) model in rats.

Materials and methods:A total of 24 rats were randomly divided into four groups: the control group administered saline; the TQ group administered 10 mg/kg/day TQ orally; lipopolysaccharide/ methylprednisolone (LPS/MPS) group administered 20 µg/kg intraperitoneally LPS and 40 mg/kg intramuscularly MPS to establish ONFH model; and the LPS/MPS+TQ group administered both LPS/MPS and, then, TQ once daily for four weeks.

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