Hepatic osteodystrophy in cirrhosis due to alcohol-related liver disease

Pereira, Flávio; Azevedo, Rita; Linhares, Marisa; Pinto, Joana; Leitão, Cátia; Caldeira, Ana Teresa; Tristan, José; Pereira, Eduardo; Sousa, Rui; Banhudo, António

doi:10.17235/reed.2020.7301/2020

Cited by 5 publications

(9 citation statements)

References 20 publications

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“…Up to 80% of cirrhotic patients demonstrate evidence of HOD. 10 Osteoporosis was found in 35% of patients with liver cirrhosis compared with 13% of controls in a meta-analysis including six case-control studies. 7 The adjusted hazard ratio for fractures was 2.4 folds higher in cirrhotic patients.…”

Section: Epidemiologymentioning

confidence: 99%

“…13 Among other liver diseases, including hereditary, viral hepatitis, alcoholic liver disease (ALD), and autoimmune hepatitis (AIH), osteoporosis is also prevalent especially in advanced cirrhotic patients. 10,[14][15][16] Liver transplantation also presents a considerable risk for HOD especially within the first year of transplantation. Several studies reported that the BMD tends to improve after the first-year posttransplant.…”

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Impact of Liver Cirrhosis on Bone Metabolism

Abdalbary

Sobh

Abdelsalam

et al. 2022

Digestive Disease Interventions

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Bone loss is an early and major problem in cirrhotic patients. The majority of cirrhotic patients demonstrate evidence of hepatic osteodystrophy (HOD). This includes decreased bone volume, turnover abnormalities, and rarely mineralization defects. Moreover, the degree of bone disease usually correlates with the severity of liver dysfunction. The mechanism of HOD is multifactorial. Vitamin D insufficiency/deficiency, secondary hyperparathyroidism, hypogonadism, inhibitors of bone formation, and mediators/promoters of bone resorption are frequent findings and essential coplayers in HOD. Early and proper identification of HOD is challenging. DXA is the most widely used tool; however, it has fundamental limitations. Bone turnover biomarkers are used to understand the mechanism of bone loss. Bone biopsy with histomorphometry is the gold standard to evaluate bone structure. The evidence for the effectiveness of nonpharmacological and pharmacological management of HOD is limited. Adequate nutrition, weight-bearing exercise, smoking cessation, and limitation of alcohol consumption improve bone health and quality of life. The use of antiresorptive therapies prevents bone loss particularly in patients with high bone turnover. However, osteoanabolics are essential in patients with low bone turnover. Herein, we are discussing the magnitude of the problem, pathogenesis, diagnosis of HOD, and various interventions to improve bone health in cirrhotic patients.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Impact of Liver Cirrhosis on Bone Metabolism

Abdalbary

Sobh

Abdelsalam

et al. 2022

Digestive Disease Interventions

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“…Recently, the magnitude of osteoporosis has been found to be increasing in LD patients [ 7 ]. These represent a major health burden, including long-term disability, inferior quality of life, increased mortality rate, and high health-care expenses [ 2 8 ]. Therefore, early identification of low bone mineral densitometry (BMD) is needed to reduce the burden of fragility fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a few studies over the years have demonstrated that the mechanism related to the development of HOD among CLD patients was found to be complex [ 8 - 10 ]. In addition, the mechanism backstage of this phenomenon is not entirely acknowledged, and chronic inflammation, insulin resistance, and Vitamin D deficiency seem to provide possible relatedness [ 11 12 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of the influential factors for hepatic osteodystrophy in chronic liver disease: A case–control survey among the patients attending a tertiary care hospital in a rural region of Northern India

Garg

Yadav

Kaur

et al. 2022

Tzu Chi Medical Journal

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A BSTRACT Objectives: Hepatic osteodystrophy (HOD) is a well-recognized complication of chronic liver diseases (CLD), but the influential factors associated with this complication were studied scarcely in a rural Indian population. The study aims to evaluate the prevalence of HOD and variables that might influence it among cases diagnosed with CLD. Materials and Methods: It is a cross-sectional observational design survey that was performed in a hospital among the two-hundred cases and controls with a 1:1 ratio who were age (>18 years) and gender matched in a period between April and October 2021. They were subjected to etiological workup, hematological and biochemical investigations, and Vitamin D levels. Then, dual-energy X-ray absorptiometry was used to measure the bone mineral densitometry (BMD) for whole-body, lumbar spine (LS), and hip. HOD was diagnosed according to the WHO criteria. Then, the Chi-square test and conditional logistic regression analysis were used to investigate the influential factors of HOD in CLD patients. Results: The whole-body, LS-spine, and hip BMDs in CLD cases were found to be significantly lower as compared to controls. When the participants among both groups were stratified by age and gender, a significant difference in LS-spine and hip BMD was observed in elderly patients (>60 years), and in both the male and female patients. HOD was found in 70% of CLD patients. After multivariate analysis in CLD patients, we identified that being a male patient (odds ratio [OR] = 3.03), older age (OR = 3.54), duration of illness for more than 5 years (OR = 3.89), decompensated liver dysfunction with Child–Turcotte–Pugh-B and C grading (OR = 8.28), and low level of Vitamin D (OR = 18.45) were the risk factors for HOD. Conclusion: This study concludes that severity of illness and lower level of Vitamin D were the main influential factors for HOD. Supplementation of Vitamin D and calcium in the patients can abate the risk of fractures in our rural communities.

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