Low bone mineral density manifests in cirrhotic patients 15 to 20 years before the usual screening age

Abstract

Introduction. Variable prevalence rates have been reported for Low bone mineral density (LBMD). Objectives. To determine the prevalence of LBMD in cirrhotic patients from a hospital outpatient clinic, to identify clinical and laboratory predictors of LBMD, and to determine the mean age at which LBMD was detected in this population. Methods. We conduced a cross-sectional study with 97 patients with liver cirrhosis for the presence of LBMD using bone densitometry of the lumbar spine and femoral neck. The prevalence of LBMD and mean age at detection of LBMD were evaluated. Correlation of LBMD with clinical-laboratory data was assessed, and uni and multivariate statistical analysis was performed. Results. The prevalence of LBMD was 50.5% in the 97 of the cases. LBMD was more frequent in participants over 50 years old (p = 0.001). There were no significant associations between the presence of LBMD and body mass index (p = 0.9), CHILD-PUGH score (p = 0.23), levels of 25-OH vitamin D (p = 0.5), parathyroid hormone (p = 0.5), calcium (p = 0.1), phosphorus (p = 0.3), and current or past smoking (p = 0.7). Age over 50 years remained a predictor of hepatic osteodystrophy even after adjusting for the other variables. Discussion. In conclusion LBMD was prevalent in the cirrhotic population studied. The age at LBMD diagnosis was between 15 and 20 years less than the osteoporosis screening age of the non-cirrhotic population. There were no clinical-laboratory factors that increased the suspicion of LBMD. Further studies are needed to determine whether these findings can be extrapolated to the cirrhotic population.

Risk Factors Associated With Fracture of the Lumbosacral Spine and Its Compromise in the Quality of Life of Cirrhotics

“…According to the 2014 Clinical Protocol and Therapeutic Guidelines for Osteoporosis (PCDT, in the Portuguese acronym) of the Brazilian Ministry of Health, the tracing of osteoporosis in women ≥65 years old and in men >70 years old is indicated, regardless of the presence of risk factors (30) . In this manual, liver cirrhosis is not included as a risk factor for osteoporosis, only primary biliary cholangitis (PBC), not contemplating other individuals with chronic hepatic disease, as has been commented in previous studies (31) .…”