The association between liver cirrhosis and fracture risk: A systematic review and meta‐analysis

Liang, Jie; Meng, Weidong; Yang, Jiancheng; Li, Sheng-Long; Zhong, Mi-Na; Hou, Xiaoyan; Wang, Ran; Long, Yu-Ying; Bao, Liangxiao; Bao, Ming

doi:10.1111/cen.13762

Cited by 32 publications

(40 citation statements)

References 23 publications

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“…Increased osteoporosis incidence is most commonly reported in cholestatic liver diseases, while less information is available regarding osteoporosis frequency in non‐cholestatic liver cirrhosis (Crawford, Kam, Donaghy, & McCaughan, 2003; Guañabens & Parés, 2018). Recent epidemiological data suggest that up to one‐third of non‐cholestatic liver cirrhosis patients, including alcoholic liver cirrhosis (ALC), are affected by osteoporosis (Ehnert et al, 2019; Liang et al, 2018). Furthermore, up‐to‐date studies in liver cirrhosis (LC) have emphasized that the lumbar spine is more likely affected than long bones (Crawford et al, 2003; Culafić et al, 2014), with a twofold vertebral fracture risk increase in LC patients (Liang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Recent epidemiological data suggest that up to one‐third of non‐cholestatic liver cirrhosis patients, including alcoholic liver cirrhosis (ALC), are affected by osteoporosis (Ehnert et al, 2019; Liang et al, 2018). Furthermore, up‐to‐date studies in liver cirrhosis (LC) have emphasized that the lumbar spine is more likely affected than long bones (Crawford et al, 2003; Culafić et al, 2014), with a twofold vertebral fracture risk increase in LC patients (Liang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Ključne reči: osteoporoza, alkoholna ciroza jetre, fragilnost kostiju, prelom kosti, mineralna gustina kosti Većina istraživačkih grupa se slaže da je učestalost fraktura dva do tri puta veća kod pacijenata sa alkoholnom cirozom u poređenju sa zdravim kontrolnim individuama (18), mada su određene studije prijavile i osmostruko povećanje rizika od preloma kosti kod ovih bolesnika (17). Mnogi autori smatraju da je lumbalni deo kičmenog stuba češće osteoporotično izmenjen u poređenju sa ostalim mestima na skeletu.…”

Section: Sažetakunclassified

“…Pored toga, mortalitet nakon preloma kosti kod bolesnika sa ACJ je značajno nepovoljniji u odnosu na pacijente bez oboljenja jetre i pokazuje trostruko povećanje u poređenju sa zdravim pojedincima iste starosti (17). Uz prethodno navedeno, alkoholna ciroza je češće prisutna kod pacijenata muškog pola, kod kojih su koštane promene i osteoporoza manje učestale u poređenju sa ženskim osobama posle menopauze (18,22). Stoga nastanak osteoporoze i udružen povećan rizik od frakture kod ACJ pacijenata predstavlja značajno socijalno-ekonomsko opterećenje zdravstvenog sistema koje zahteva razvoj efikasnih mera prevencije, dijagnoze i lečenja.…”

Section: Sažetakunclassified

Compromised bone strength in patients with alcoholic liver cirrhosis

Jadžić¹,

Đonić²

2020

Medicinski podmladak

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Osteoporoza i/ili osteopenija su česte komplikacije alkoholne bolesti jetre, sa posebnim značajem u njenom ireverzibilnom stadijumu (engl. alcoholic liver cirrhosis – ALC). U ovoj publikaciji je predstavljen pregled savremene literature o učestalosti osteoporoze, povećanom riziku od preloma kosti, promenama mineralne gustine i mikrostrukture kostiju, kao i o etio-patogenetskim mehanizmima koji dovode do smanjenja kvaliteta kosti kod pacijenata sa ALC-om. Zabeleženo je da osteoporoza može biti prisutna kod značajnog broja ALC bolesnika, naročito u slabinskom delu kičmenog stuba. Identifikovano je više faktora rizika, kao i etio-patogenetskih mehanizama povezanih sa gubitkom mineralne gustine kosti kod bolesnika sa alkoholnom i cirozama druge etiologije. Određeni autori tvrde da je dominantan mehanizam gubitka koštane mase usporeno osteoblastno stvaranje kosti, dok drugi rezultati sugerišu pojačanu razgradnju koštanog matriksa kao dominantniji mehanizam u nastanku skeletnih oštećenja kod ALC bolesnika. Povećana koštana fragilnost i sklonost ka patološkim prelomima značajno utiču na životni vek i kvalitet života pacijenata sa ALC-om. Stoga se preporučuje da osteološki skrining i procena rizika od frakture budu obavezni deo individualnog pristupa lečenju bolesnika sa alkoholnom cirozom jetre.

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“…One of the most common triggers are infections, however, decompensation may also be triggered in the sequalae of other complications, eg bone fractures and subsequent immobilisation or surgery 3 . Recent studies suggested that patients with liver cirrhosis are per se at a higher risk for fractures when compared to patients without liver diseases 4‐6 . Given the economic burden for health care systems caused by bone fractures and the burden to patients, it is of pivotal importance to identify potential modifiable risk factors for the occurrence of fractures in high‐risk patient populations.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

Labenz

Wörns

Adarkwah

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundBone fractures are a frequent complication in patients with cirrhosis. Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and may impair bone quality and quantity.AimsTo investigate whether PPI use predisposes patients with cirrhosis to bone fractures.MethodsWe performed a population‐based case‐control study exploring a sample of patients with cirrhosis derived from the Disease Analyzer database. In total, 1795 cirrhotic patients with fractures were compared to 10 235 cirrhotic patients without fractures. PPI use overall and the cumulative PPI dose 5 years prior to the index date were analysed. To estimate the association between PPI use and fractures, logistic regression analyses were performed taking cofounding factors into consideration.ResultsPPI use was more frequently seen in cirrhotic patients with fractures compared to controls (67.0% vs 53.4%, P < 0.001). In regression analyses, PPI use was associated with bone fractures after adjusting for important confounders (OR 1.34, 95% CI 1.20‐1.51, P < 0.001). Importantly, the strongest effect of PPIs on bone fractures was seen in men and patients below 70 years of age. On further sensitivity analyses, we observed a dose‐dependent effect for all PPIs with the strongest effect in cirrhotic patients receiving a dose of >50 000 mg during the 5 years prior to index date (OR 1.63, 95% CI 1.32‐2.03).ConclusionsPPI use was associated with bone fractures in a dose‐dependent fashion in patients with cirrhosis. PPI use in these patients should be based on a careful risk‐benefit assessment.

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The association between liver cirrhosis and fracture risk: A systematic review and meta‐analysis

Abstract: In conclusion, this study indicates that cirrhotic patients have an increased risk of fracture. Preventive measures should be instituted as early as possible.

Cited by 32 publications

References 23 publications

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

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

Compromised bone strength in patients with alcoholic liver cirrhosis

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

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