Prevalence and prediction of osteopenia in chronic liver disease

Abstract

To obtain information on the prevalence and clinical and laboratory correlates of osteopenia in patients with chronic liver disease, we measured bone densities and 30 selected laboratory variables in 133 subjects (70 men, 63 women) with liver disease. Thirty-two had alcoholic liver disease, 18 had primary biliary cirrhosis, 16 had primary sclerosing cholangitis, 48 had other forms of cirrhosis (cryptogenic, posthepatic) and 19 had chronic hepatitis or fibrosis without cirrhosis. Bone densities of the lumbar spine and three sites of the proximal femur (neck, Ward's triangle, greater trochanter) were estimated by dual-photon absorptiometry. Bone densities at all sites were significantly correlated to one another (r = 0.4 to 0.9; 95% confidence intervals = 0.24-0.54 to 0.81-0.90; p less than 0.0001 for all). Compared with an age- and gender-matched reference group, patients with liver disease had highly significant decreases in bone densities (greater than 2 standard deviations below control values; p less than 0.0008 at all sites). Decreases were particularly marked (24% to 42%) at Ward's triangle, the site of the femoral neck particularly prone to fracture. The prevalence of decreased bone densities ranged from 10% to 56%, depending on the site studied and the nature of the liver disease. Among 30 laboratory variables studied, there were significant (p less than 0.05) correlations with bone densities at more than one site for urinary creatinine (r = 0.21, 0.25), urinary calcium (r = -0.18, -0.23), serum total alkaline phosphatase (r = -0.18, -0.27) and the liver-1 isozyme of serum alkaline phosphatase (r = -0.19, -0.26).(ABSTRACT TRUNCATED AT 250 WORDS)

Whole body and regional body composition analysis by dual-energy X-ray absorptiometry in cirrhotic patients

“…Previous observations on reduced bone mineral content and density in cirrhotic patients (Bonkovsky et al, 1990) are con®rmed in our study. Bone loss in patients with cirrhosis of various etiology and not only in those affected by alcoholic or cholestatic liver diseases has emerged as a clinical problem, because bone alterations are not corrected but are even accentuated after liver transplantation (Meys et al, 1994).…”

Serial measurements of bone density at the lumbar spine do not predict fracture risk after liver transplantation

“…In accordance with previously reported data, our data show that patients with alcoholic liver disease were less likely to have osteoporosis and patients with PBC were more likely to experience bone loss. 1,8,13,23 In our study, we report a significantly greater incidence of fractures in female liver transplant recipients compared with male transplant recipients. Female patients were more likely to be shorter, have PBC, have a family history of osteoporosis, experience acute rejection episodes, and be administered greater cumulative doses of steroids.…”

“…The impact of liver disease on bone mineral density (BMD) before transplantation has been documented. 7,8 Diamond et al 7 showed osteoporotic changes in 21% of patients, and Bonkovsky et al 8 showed a prevalence of decreased BMD ranging from 10% to 56%, depending on the cause of liver failure. It appears that patients with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC) are at the greatest risk for pretransplantation osteoporosis.…”

Clinical benefits of biochemical markers of bone turnover in Egyptian children with chronic liver diseases

“…Bone loss is a result of an imbalance of the bone remodeling process, where bone resorption exceeds bone formation [4] . The prevalence of osteoporosis in patients with chronic liver diseases ranges from 10% to 60% [5,6] . In general, secondary factors such as malabsorption and nutritional deficiencies may cause bone changes in chronic liver disease [7] .…”