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. 2020 May 21;1(2):48-52.
doi: 10.14744/hf.2020.2020.0007. eCollection 2020 May.

Prevalence and characteristics of bone disease in cirrhotic patients

Hale Gokcan  1 , Meral Akdogan Kayhan  1 , Sibel Ozbudak Demir  2 , Sabite Kacar  1 , Pinar Cam  2 , Mustafa Kaplan  1 , Rabia Daylak  2 , Derya Oztuna  3 , Sedef Özdal Kuran  4 , Derya Ari  1
Affiliations

Prevalence and characteristics of bone disease in cirrhotic patients

Hale Gokcan et al. Hepatol Forum. .

Abstract

Background and aim: Chronic liver disease is a risk factor for osteoporosis, osteopenia and bone fractures. In this study, prevalence and risk factors of osteoporosis and vitamin D deficiency and also their effects on survival were investigated in 218 patients with chronic liver disease.

Materials and methods: Prevalence of osteoporosis and vitamin D levels was calculated. Risk factors for osteoporosis (gender, age, body mass index, etiology), serum bilirubin, albumin, 25-hydroxy (OH) vitamin D, parathyroid hormone levels, bone mineral density (BMD) with DEXA, bone formation (osteocalcin) and bone resorption (type 1 collagen) levels, Model for End-Stage Liver Disease (MELD) Na and Child-Pugh (CP) score were recorded. The effects of vitamin D levels and BMD on survival were evaluated.

Results: One hundred forty-seven (67.4%) patients were female (mean age, 50.4±11.7). Patients were Child A by 40.8%, Child B by 47.1%, and Child C by 12.1%. Mean MELD Na score was 8.4±2.8. Data of the BMD were established in 218 patients and 25-OH D levels in 122 patients. Mean serum 25-OH D level was 14.26±9.44 ng/mL. Osteoporosis was identified in 42 (19.3%) and osteopenia in 115 (52.8%) patients, according to BMD. Osteocalcin levels and collagen type 1 levels were high in 25.6% and 12.5% of patients, respectively. No statistically difference was found, including gender (p=0.69), age (p=0.38), etiology (p=0.16), BMI (p=0.32), CP score (p=0.42), MELD (0.14), albumin (p=0.11), total bilirubin (p=0.99), Ca (0.67), PTH (0.88), osteocalcin (0.92), collagen type 1(p=0.25) between osteoporotic and non-osteoporotic patients. Patients were followed-up for a median of 30.07±11.83 months after BMD measurement. Fifty-four (24.8%) patients died during the follow-up period, none of them are related to bone fracture. There was no statistically difference on survival between osteoporosis group (32.2±2.3 months) and non-osteoporosis group (37.2±1.7 months; p=0.26) or when patients with 25-OH D3 ≤10 ng/mL were compared to patients with 25-OH D3 >20 ng/mL (34.4±2.0 months vs. 39.1±1.6 months, p=0.308).

Conclusion: In conclusion, the prevalence of bone disease was found to be higher in cirrhotic patients. Although osteoporosis and vitamin D deficiency were found to decrease survival, this effect was not statistically significant. We suggest designing multi-institutional and/or multinational studies with larger and more heterogenous patient groups would enable better testing of this phenomenon.

Keywords: 25-OH vitamin D; chronic liver disease; osteopenia; osteoporosis; survival.

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Conflict of interest statement

The authors do not have any conflict of interest.

Figures

Figure 1
Figure 1
Survival according to bone mineral density status.
Figure 2
Figure 2
Survival according to 25-OH D level.
See this image and copyright information in PMC

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