Osteoporosis in chronic liver disease

Guañabens, Núria; Parés, Albert

doi:10.1111/liv.13730

Cited by 87 publications

(99 citation statements)

References 113 publications

(233 reference statements)

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“…Although our meta‐analysis did not show any significant and consistent difference in BMD at various skeletal sites according to NAFLD severity, it is known that osteoporosis is a frequent complication in patients with cirrhosis, especially in those with alcoholic cirrhosis or advanced cholestatic liver disease . In this clinical setting, the main risk factors are disease severity, older age and duration of cholestasis.…”

Section: Discussioncontrasting

confidence: 58%

“…In this clinical setting, the main risk factors are disease severity, older age and duration of cholestasis. Abnormalities in endocrine system and homeostasis, such as hypogonadism and vitamin D 3 deficiency, as well as malnutrition and drug‐induced effects, may also be involved in osteoporosis development among cirrhotic patients . Less is currently known about the presence of bone and mineral disorders in NAFLD.…”

Section: Discussionmentioning

confidence: 99%

“…There is now emerging evidence of biological plausibility that NAFLD may increase risk of osteoporotic fractures. 10,36,37 Indeed, NAFLD (especially non-alcoholic steatohepatitis [NASH] with varying levels of hepatic fibrosis) may exacerbate insulin resistance and causes the release of multiple pro-inflammatory cytokines and boneinfluencing molecules that may promote bone demineralisation and osteoporosis. 10,36,37 According to the findings of this meta-analytic study, it is possible to speculate that there may also be a sex-related differential effect of NAFLD on fracture risk.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Mantovani

Dauriz

Gatti

et al. 2019

Aliment Pharmacol Ther

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Summary Background Several studies have explored the effect of non‐alcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and risk of osteoporotic fractures in adults. However, the extent to which NAFLD adversely affects bone health remains uncertain. Aim To provide a quantitative estimation of the magnitude of the association of NAFLD with BMD or history of osteoporotic fractures in adults. Methods We searched PubMed, Web of Science, and Scopus using predefined keywords to identify all observational studies, published up to 31 August 2018, in which NAFLD was diagnosed by imaging or histology; BMD was measured by dual energy X‐ray absorptiometry; and a self‐reported history of osteoporotic fractures was collected with interviewer‐assisted questionnaires. Data from selected studies were extracted, and meta‐analysis was performed using random‐effects modelling. Results Twelve cross‐sectional or case‐control studies with aggregate data on 30 041 adults of predominantly Asian ethnicity (30% with NAFLD) were included in the final analysis. No significant differences in BMD at different skeletal sites (whole body, lumbar spine, or femur) were observed between individuals with and without NAFLD. Conversely, NAFLD was associated with increased odds of osteoporotic fractures, especially in older Chinese men (n = 2 studies; random‐effects odds ratio 2.10, 95% CI 1.36‐3.25; I2 = 0%). Sensitivity analyses did not alter these findings. The funnel plot and Egger test did not reveal significant publication bias. Conclusions This meta‐analysis suggests that imaging‐defined or biopsy‐proven NAFLD is associated with a self‐reported history of osteoporotic fractures (principally in Chinese men), but not with low BMD, in middle‐aged and elderly individuals.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Mantovani

Dauriz

Gatti

et al. 2019

Aliment Pharmacol Ther

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“…The finding of a significant, graded relationship between the histological severity of NAFLD and whole‐body BMD Z scores is particularly relevant in view of the disease burden that NAFLD represents and the potential impact on health care resources needed to survey and manage these patients adequately. It is known that osteoporosis and osteomalacia are two frequent complications in adult patients with cirrhosis, especially in those with alcoholic cirrhosis or advanced cholestatic liver disease . However, because our results are only based on four cross‐sectional studies (involving a total of 184 overweight/obese adolescents with biopsy‐proven NASH or no‐NASH), we believe that this question remains currently unresolved, and further larger studies are needed in order to prove whether the histological severity of NAFLD adversely affects bone health in childhood.…”

Section: Discussionmentioning

confidence: 94%

“…It is known that osteoporosis and osteomalacia are two frequent complications in adult patients with cirrhosis, especially in those with alcoholic cirrhosis or advanced cholestatic liver disease. (29,30) However, because our results are only based on four cross-sectional studies (involving a total of 184 overweight/obese adolescents with biopsy-proven NASH or no-NASH), we believe that this question remains currently unresolved, and further larger studies are needed in order to prove whether the histological severity of NAFLD adversely affects bone health in childhood.…”

Section: Discussionmentioning

confidence: 98%

Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

et al. 2019

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Recent cross‐sectional studies have examined the association between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) in children or adolescents, but these have produced conflicting results. We performed a systematic review and meta‐analysis of these published studies to quantify the magnitude of the association, if any, between NAFLD and BMD. We searched publication databases from January 2000 to September 2018, using predefined keywords to identify relevant observational studies conducted in children or adolescents in whom NAFLD was diagnosed either by imaging or by histology and BMD Z score was measured by dual‐energy X‐ray absorptiometry. Data from selected studies were extracted, and a meta‐analysis was performed using random‐effects modeling. A total of eight observational cross‐sectional or case–control studies enrolling 632 children and adolescents (mean age 12.8 years), 357 of whom had NAFLD, were included in the final analysis. Meta‐analysis showed significant differences in whole‐body or lumbar BMD Z scores between children/adolescents with and without NAFLD (n = 6 studies; pooled weighted mean difference [WMD], –0.48; 95% confidence interval [CI], –0.74 to –0.21; I2 = 55.5%), as well as between those with biopsy‐confirmed nonalcoholic steatohepatitis (NASH) and those with no‐NASH (n = 4 studies; pooled WMD, –0.27; 95% CI, –0.40 to –0.13; I2 = 0%). The aforementioned WMDs in BMD Z scores were independent of common clinical risk factors, such as age, sex, race/ethnicity, and body mass index. Sensitivity analyses did not modify these findings. Funnel plot and Egger test did not reveal significant publication bias. Conclusion: This meta‐analysis shows that the presence and severity of NAFLD are significantly associated with reduced whole‐body BMD Z scores in children and adolescents; however, the observational design of the studies included does not allow for proving causality.

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The severity of hepatic disorder is related to vertebral microstructure deterioration in cadaveric donors with liver cirrhosis

Jadžić

Cvetković

Tomanović

et al. 2020

Microscopy Res & Technique

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Patients with liver cirrhosis (LC) commonly suffer from osteoporosis and vertebral fracture, but data about their vertebral micro‐architectural changes are still limited. This study aimed to evaluate the potential differences in trabecular micro‐architecture of lumbar vertebrae between male LC patients and healthy controls, in relation to etiology and pathohistological scoring of the liver disorder. After pathohistological examination of liver tissue, micro‐computed tomography was performed on the vertebral samples included into: alcoholic liver cirrhosis group (ALC; n = 16; age: 59 ± 8 years), non‐alcoholic liver cirrhosis group (non‐ALC; n = 15; age: 69 ± 10 years) and control group (n = 16; age: 58 ± 6 years). Our data showed significant impairment of the trabecular microstructure in the lumbar vertebrae from LC donors, regardless of the alcoholic/non‐alcoholic origin of liver disorder, as illustrated by lower BV/TV, Tb.Th, and Tb.N compared with controls (p < .05). Moreover, depredation in trabecular micro‐architecture was inversely associated with pathohistological scores (p < .05), indicating that severity of liver disorder could be an important predictor of reduced vertebral strength in LC. We noticed significant micro‐architectural deterioration in the trabecular compartment of the lumbar vertebrae of male individuals with alcoholic and non‐alcoholic LC, which was associated with the severity of the liver disease. Thus, clinical assessment of fracture risk should be advised for all LC patients, regardless of the alcoholic origin of liver cirrhosis. Additionally, adequate and timely treatment of liver disorder may decelerate the progression of bone impairment in LC patients.

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Osteoporosis in chronic liver disease

Cited by 87 publications

References 113 publications

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Systematic review with meta‐analysis: non‐alcoholic fatty liver disease is associated with a history of osteoporotic fractures but not with low bone mineral density

Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

The severity of hepatic disorder is related to vertebral microstructure deterioration in cadaveric donors with liver cirrhosis

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