Safety and efficacy of risedronate for patients with esophageal varices and liver cirrhosis: a non-randomized clinical trial

Lima, Tiago Barbalho; Santos, L.; Nunes, Hélio Rubens de Carvalho; Silva, Giovanni Faria; Caramori, Carlos Antonio; Qi, Xingshun; Romeiro, Fernando Gomes

doi:10.1038/s41598-019-55603-y

Cited by 9 publications

(9 citation statements)

References 38 publications

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“…Because cirrhosis-related osteoporotic fractures are associated with disability, decreased quality of life, and an increased risk of death, all cirrhotic patients should undergo bone densitometry during their clinical course [ 4 ]. In addition, recent evidence has shown that osteoporosis can be safely treated with risedronate in patients with liver cirrhosis [ 22 ]. BMD is a useful indicator to diagnose osteoporosis [ 7 , 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis

Ogiso¹,

Hanai²,

Nishimura³

et al. 2022

JCM

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The trabecular bone score (TBS), a surrogate measure of bone microarchitecture, provides complementary information to bone mineral density (BMD) in the assessment of osteoporotic fracture risk. This cross-sectional study aimed to determine whether TBS can identify patients with liver cirrhosis that are at risk of vertebral fractures. We enrolled 275 patients who completed evaluations for lumbar BMD, TBS, and vertebral fractures between November 2018 and April 2021. BMD was measured using dual-energy X-ray absorptiometry (DXA), TBS was calculated by analyzing DXA images using TBS iNsight software, and vertebral fractures were evaluated using Genant’s semi-quantitative method with lateral X-ray images. Factors associated with vertebral fractures and their correlation with the TBS were identified using regression models. Of the enrolled patients, 128 (47%) were female, the mean age was 72 years, and 62 (23%) were diagnosed with vertebral fractures. The prevalence of vertebral fractures was higher in women than in men (33% vs. 14%; p < 0.001). The unadjusted odds ratio (OR) of the vertebral fractures for one standard deviation decrease in TBS and BMD was 2.14 (95% confidence interval [CI], 1.69–2.73) and 1.55 (95% CI, 1.26–1.90), respectively. After adjusting for age, sex, and BMD, the adjusted OR of the vertebral fractures in TBS was 2.26 (95% CI, 1.52–3.35). Multivariate linear regression analysis showed that TBS was independently correlated with age (β = −0.211), body mass index (β = −0.251), and BMD (β = 0.583). TBS can help identify patients with cirrhosis at risk of vertebral fractures.

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Section: Discussionmentioning

confidence: 99%

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis

Ogiso¹,

Hanai²,

Nishimura³

et al. 2022

JCM

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“…Particular attention must be given to patients with ACLD with a high risk of oesophageal varices since esophagitis and oesophageal ulcers are side-effects of oral bisphosphonates. In these patients, parenteral bisphosphonates can be proposed[ 99 , 100 ].…”

Section: Management Of Osteosarcopenia In Cldmentioning

confidence: 99%

Osteosarcopenia in autoimmune cholestatic liver diseases: Causes, management, and challenges

Pugliese¹,

Arcari²,

Aghemo³

et al. 2022

WJG

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Primary biliary cholangitis and primary sclerosing cholangitis (PSC) are the most common cholestatic liver diseases (CLD) in adults and are both characterized by an immune pathogenesis. While primary biliary cholangitis is a model autoimmune disease, with over 90% of patients presenting very specific autoantibodies against mitochondrial antigens, PSC is considered an immune mediated disease. Osteoporosis is the most common bone disease in CLD, resulting in frequent fractures and leading to significant morbidity. Further, sarcopenia is emerging as a frequent complication of chronic liver diseases with a significant prognostic impact and severe implications on the quality of life of patients. The mechanisms underlying osteoporosis and sarcopenia in CLD are still largely unknown and the association between these clinical conditions remains to be dissected. Although timely diagnosis, prevention, and management of osteosarcopenia are crucial to limit the consequences, there are no specific guidelines for management of osteoporosis and sarcopenia in patients with CLD. International guidelines recommend screening for bone disease at the time of diagnosis of CLD. However, the optimal monitoring strategies and treatments have not been defined yet and vary among centers. We herein aim to comprehensively outline the pathogenic mechanisms and clinical implications of osteosarcopenia in CLD, and to summarize expert recommendations for appropriate diagnostic and therapeutic approaches.

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“…107 Lima et al showed that oral bisphosphonates can be used in cirrhotic patients with low-risk esophageal varices under endoscopic surveillance. 108…”

Section: Bisphosphonatesmentioning

confidence: 99%

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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Safety and efficacy of risedronate for patients with esophageal varices and liver cirrhosis: a non-randomized clinical trial

Cited by 9 publications

References 38 publications

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis

Osteosarcopenia in autoimmune cholestatic liver diseases: Causes, management, and challenges

Impact of Liver Cirrhosis on Bone Metabolism

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