The Factors Affecting Bone Density in Cirrhosis

Abstract

Background:Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.Objectives:We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it.Patients and Methods:In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.Results:A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m2 were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.Conclusions:Abnormal DEXA was highly prevalent among patients with cirrhosis. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function.

Significant liver fibrosis assessed using liver transient elastography is independently associated with low bone mineral density in patients with non-alcoholic fatty liver disease

“…Therefore, our results showing a strong association between low BMD and significant liver fibrosis in NAFLD may be partly explained by the development of osteopenia through the systemic inflammation and insulin resistance observed in this disorder. Vitamin D deficiency may also contribute to worsening bone health in chronic liver disease [ 30 , 42 ]. Indeed, 92% of patients with chronic liver disease revealed vitamin D deficiency, although most had chronic hepatitis C [ 43 ].…”

Suboptimal Level of Bone‐Forming Cells in Advanced Cirrhosis are Associated with Hepatic Osteodystrophy

“…Bone mass is determined by two factors: peak bone mass accumulated throughout growth and continuous consolidation and resorption of the bone thereafter . Most of our knowledge has been attained from studies on primary biliary cirrhosis .…”

Cirrhosis-related musculoskeletal disease: radiological review

“…The fracture rate ranges from 5 to 20%. 34,35 Vertebral fractures are most frequent in these patients, manifesting in 3-18% of cases (Figures 10 and 11). Therefore, an assessment of risk factors for bone loss and bone mineral density measurement should be a part of routine protocol in patients with chronic liver disease.…”