Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

Hidalgo, Diego; Boonpheng, Boonphiphop; Phemister, Jennifer; Young, Mark

doi:10.14309/00000434-201810001-00899

Cited by 3 publications

(4 citation statements)

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“…There are many reasons why metabolic changes that are caused by liver cirrhosis could have an impact on the early stages of osseointegration. Cirrhosis is a risk factor for osteoporotic fractures suggesting an effect of cirrhosis on bone metabolism that may extend toward bone regeneration (Handzlik‐Orlik et al., 2016; Hidalgo et al., 2020; Luxon, 2011). Also, the frequency of oral mucosal lesions in patients with chronic liver failure was higher compared with the control group (Zahed et al., 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of cirrhosis in industrialized countries is estimated at 0.3% (Scaglione et al., 2015). Regardless of the etiology, cirrhosis doubles the risk of pathological fractures (Handzlik‐Orlik et al., 2016; Hidalgo et al., 2020; Luxon, 2011). Moreover, cirrhotic patients with fractures had significantly higher mortality and hospitalization rate than the regular population (Mavilia et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

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Bone healing around titanium implants in a preclinical model of bile duct ligation‐induced liver injury

Talebian

Kampleitner

Sagl

et al. 2021

Clinical Oral Implants Res

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Objectives Chronic liver disease increases the risk for periodontal disease and osteoporotic fractures, but its impacts on bone regeneration remain unknown. Herein, we studied the impact of liver cirrhosis on peri‐implant bone formation. Material and Methods A total of 20 male Wistar rats were randomly divided into two groups: one with the common bile duct ligated (BDL) and the respective sham‐treated control group (SHAM). After four weeks of disease induction, titanium mini‐screws were inserted into the tibia. Successful induction of liver cirrhosis was confirmed by the presence of clinical symptoms. Another four weeks later, peri‐implant bone volume per tissue volume (BV/TV) and bone‐to‐implant contact (BIC) were determined by histomorphometric analysis. Results Peri‐implant bone formation was not significantly different between the SHAM and BDL groups. In the cortical compartment, the median percentage of peri‐implant new bone was 10.1% (95% CI of mean 4.0–35.7) and 22.5% (13.8–30.6) in the SHAM and BDL groups, respectively (p = .26). Consistently, the new bone in direct contact with the implant was 18.1% (0.4–37.8) and 23.3% (9.2–32.8) in SHAM and BDL groups, respectively (p = .38). When measuring the medullary compartment, the new bone area was 7.1% (4.8–10.4) and 10.4% (7.2–13.5) in the SHAM and BDL groups, respectively (p = .17). Medullary new bone in direct contact with the implant was 10.0% (1.2–50.4) and 20.6% (16.8–35.3) in SHAM and BDL groups, respectively, and thus comparable between the two groups (p = .46). Conclusions Bile duct ligation has no significant impact on the early stages of peri‐implant bone formation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bone healing around titanium implants in a preclinical model of bile duct ligation‐induced liver injury

Talebian

Kampleitner

Sagl

et al. 2021

Clinical Oral Implants Res

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“…Early detection and lifestyle modification could potentially decrease the risk of osteoporosis and hence the fractures in patients with CLD. This work has been presented as an abstract [29].…”

Section: Discussionmentioning

confidence: 99%

Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

Hidalgo

Boonpheng

Sikandar

et al. 2020

Cureus

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Introduction Chronic liver disease (CLD) causes more than 1 million deaths every year and remains a pandemic in the last decade affecting more than 600,000 patients in the United States. Previous studies found patients with CLD had increased risk of osteoporosis, so fractures were inferred to be complications of this condition. The aim of this meta-analysis is to summarize the best evidence that correlates CLD patients and the risk to develop osteoporotic fractures versus control patients without CLD. Methods A review of the literature using MEDLINE and EMBASE database was performed during December 2017. We included cross-sectional and cohort studies that reported relative risks (RR), odds ratios (OR) and hazard ratios (HR) comparing the risk of developing osteoporotic fractures among patients with CLD versus patients without CLD. Pooled OR and 95% confidence interval (CI) were calculated using generic inverse-variance method. The Newcastle-Ottawa scale was used to determine the quality of the studies. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results After the review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. Significant association was found between CLD and osteoporotic fractures with a pooled OR of 2.13 (95% CI, 1.79-2.52). High heterogeneity among the studies was found (I2=88.5). No publication bias was found using Egger regression test (p=0.44). Conclusion We found a significant association between CLD and the risk of developing osteoporotic fractures. The calculated risk was 2.13 times higher for patients with CLD when compared with controls. The results showed high heterogeneity but no publication bias. More prospective studies are needed to fully understand the mechanisms involved in loss of bone density and osteoporotic fractures in order to improve the morbidity associated with this disease.

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“…Hepatic osteodystrophy is common in patients with advanced cirrhosis (4)(5)(6). Decline in bone mineral density (BMD) is invariably associated with poor quality of life and increased risk of fractures in this population (7). However, unlike muscle and fat mass, impact of BMD or changes in it on liver related outcomes is poorly understood at present.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes in bone mineral density are associated with long-term survival in patients with cirrhosis: A proof of concept study

Agarwal

Grover

Singh

et al. 2023

Preprint

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Background The impact of longitudinal changes in different body components measured via body composition analysis(BCA) on liver related outcomes in patients with cirrhosis is poorly understood. We evaluated the prognostic relevance these changes in body composition over 1 year in patients with cirrhosis with regard to their long-term outcomes. Methods This was a follow-up study of a randomised controlled trial evaluating changes in bone density measured via dual energy X-ray absorptiometry(DEXA) upon vitamin-D supplementation. Patients with available anthropometric indices, fat mass(FM), fat-free mass(FFM), bone-density at lumbar spine(LD) and left femur-neck(FD)(assessed by T-score) at two time points 1 year apart were assessed for outcomes. The prognostic relevance of change in parameters like ΔFM, ΔFFM, ΔLD and ΔFD over 1 year was assessed and compared with baseline model for end stage liver disease(MELD) score. Results Patients with cirrhosis(n = 112) (mean age-41.8 ± 12 years, 58.5% males) were followed up for median duration of 5.7 years(IQR:3.5–5.7), with 5-year survival rate of 77%. On serial BCA, ΔLD(p = 0.029) and ΔFD(p = 0.003) emerged as significant predictors of survival whereas ΔFM(p = 0.479), ΔFFM(p = 0.245) and ΔBMI (p = 0.949) were not. The area under curve of ΔLD and MELD score for predicting survival was 0.636(0.5-0.773) and 0.664(0.555–0.773), respectively. ΔFD < 0.1 over 1 year had sensitivity and specificity of 70.4% and 56.5% to predict poor survival. Combination of ΔFD, MELD and ascites predicted 5-yr survival with an optimism-corrected c-statistic of 0.785. Conclusion Among body composition parameters, changes in bone mineral density correlate best with long-term survival with prognostic relevance similar to that of ascites and MELD score.

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Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

Cited by 3 publications

References 0 publications

Bone healing around titanium implants in a preclinical model of bile duct ligation‐induced liver injury

Bone healing around titanium implants in a preclinical model of bile duct ligation‐induced liver injury

Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

Longitudinal changes in bone mineral density are associated with long-term survival in patients with cirrhosis: A proof of concept study

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