Year 2021 / Volume 113 / Number 8
Original
Hepatic osteodystrophy in cirrhosis due to alcohol-related liver disease

563-569

DOI: 10.17235/reed.2020.7301/2020

Flávio Pereira, Richard Azevedo, Marisa Linhares, João Pinto, Cátia Leitão, Ana Caldeira, José Tristan, Eduardo Pereira, Rui Sousa, António Banhudo,

Abstract
Introduction: hepatic osteodystrophy, including osteoporosis, is an abnormal bone metabolism related with chronic liver diseases. Osteoporosis is associated with an increased risk of bone fractures, with a significant impact on morbidity, mortality and healthcare costs. Nevertheless, bone disorders tend to be undervalued in cirrhosis due to alcohol-related liver disease (ALD cirrhosis). This study aimed to assess the prevalence of hepatic osteodystrophy and osteoporosis in ALD cirrhosis. Methods: a prospective observational study was performed that included patients with ALD cirrhosis, between September 2017 and December 2018. Bone mineral density was determined by dual energy X-ray absorptiometry at the lumbar spine and the femoral neck. Hepatic osteodystrophy was defined as a T-score below -1 SD and osteoporosis as a T-score below -2.5 SD. Results: ninety-four patients were included; 24.5 % (n = 23) had prior fragility fractures and ten patients suffered new osteoporotic fractures during the study period. Hepatic osteodystrophy was diagnosed in 79.8 % (n = 75) and osteoporosis in 21.3 % (n = 20) of cases. Patients with hepatic osteodystrophy presented significantly worse Child-Turcotte-Pugh (p < 0.05) and Model for End-Stage Liver Disease (MELD-sodium) scores (p = 0.01). According to the multivariate analysis, lower body mass index (BMI) (OR = 0.787, 95 % CI: 0.688-0.901, p = 0.001) and vitamin D deficiency (OR = 6.798, 95 % CI: 1.775-26.038, p = 0.005) were significantly and independently associated with hepatic osteodystrophy. Patients with osteoporosis also had a lower BMI (p = 0.01). Female patients and those with prior fragility fractures were more likely to suffer from osteoporosis (p < 0.05). Conclusion: our study revealed a high prevalence of hepatic osteodystrophy and osteoporosis in patients with ALD cirrhosis (particularly in those with a lower BMI) and a concerning high rate of fragility fractures. Bone mineral density should be assessed in order to allow for an early diagnosis and the implementation of preventive measures.
Share Button
New comment
Comments
No comments for this article
References
1. Yadav A, Carey EJ. Osteoporosis in chronic liver disease. Nutr Clin Pract. 2013;28(1):52–64.
2. Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol [Internet]. 2019;70(1):172–93. Available from: https://doi.org/10.1016/j.jhep.2018.06.024
3. Luxon BA. Bone disorders in chronic liver diseases. Curr Gastroenterol Rep. 2011;13(1):40–8.
4. Pietri M, Lucarini S. The orthopaedic treatment of fragility fractures. Clin Cases Miner Bone Metab. 2007;4(2):108–16.
5. George J, Ganesh HK, Acharya S, et al. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol. 2009;15(28):3516–22.
6. Wariaghli G, Allali F, Maghraoui A El, et al. Osteoporosis in patients with primary biliary cirrhosis. Eur J Gastroenterol Hepatol. 2010;22(12):1397–401.
7. Carey EJ, Balan V, Kremers WK, et al. Osteopenia and osteoporosis in patients with end-stage liver disease caused by hepatitis C and alcoholic liver disease: Not just a cholestatic problem. Liver Transplant. 2003;9(11):1166–73.
8. Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol [Internet]. 2019;70(1):151–71. Available from: https://doi.org/10.1016/j.jhep.2018.09.014
9. Sheron N. Alcohol and liver disease in Europe - Simple measures have the potential to prevent tens of thousands of premature deaths. J Hepatol [Internet]. 2016;64(4):957–67. Available from: http://dx.doi.org/10.1016/j.jhep.2015.11.006
10. Yoon Y, Yi H. SURVEILLANCE REPORT 83 LIVER CIRRHOSIS MORTALITY IN THE UNITED STATES , 1970 – 2005 U . S . Department of Health and Human Services Public Health Service. 2008;
11. Santos LAA, Romeiro FG. Diagnosis and Management of Cirrhosis-Related Osteoporosis. Biomed Res Int. 2016;2016.
12. López-Larramona G, Lucendo AJ, González-Castillo S, et al. Hepatic osteodystrophy: An important matter for consideration in chronic liver disease. World J Hepatol. 2011;3(12):300–7.
13. Bansal RK, Kumar M, Sachdeva PRM, et al. Prospective study of profile of hepatic osteodystrophy in patients with non-choleastatic liver cirrhosis and impact of bisphosphonate supplementation. United Eur Gastroenterol J. 2016;4(1):77–83.
14. Choudhary NS, Tomar M, Chawla YK, et al. Hepatic osteodystrophy is common in patients with noncholestatic liver disease. Dig Dis Sci. 2011;56(11):3323–7.
15. Cijevschi C, Mihai C, Zbranca E, et al. Osteoporosis in liver cirrhosis. Rom J Gastroenterol. 2005;14(4):337–41.
16. Peris P, Parés A, Guan̄abens N, et al. Bone mass improves in alcoholics after 2 years of abstinence. J Bone Miner Res. 1994;9(10):1607–12.
17. Branco JC, Rodrigues AM, Gouveia N, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: Results from EpiReumaPt- a national health survey. RMD Open. 2016;2(1).
18. Liang J, Meng WD, Yang JM, et al. The association between liver cirrhosis and fracture risk: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;89(4):408–13.
19. Nuti R, Brandi ML, Checchia G, et al. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med [Internet]. 2019;14(1):85–102. Available from: https://doi.org/10.1007/s11739-018-1874-2
20. Xiang BY, Huang W, Zhou GQ, et al. Body mass index and the risk of low bone mass-related fractures in women compared with men: A PRISMA-compliant meta-analysis of prospective cohort studies. Med (United States). 2017;96(12):10–5.
21. Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol [Internet]. 2018;69(1):154–81. Available from: https://doi.org/10.1016/j.jhep.2018.03.018
22. Barrionuevo P, Kapoor E, Asi N, et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: A network meta-analysis. J Clin Endocrinol Metab. 2019;104(5):1623–30.
23. National Osteoporosis Guideline Group. NOGG 2017: Clinical Guidelines for the Prevention and Treatment of Osteoporosis. 2018;(July):1–36. Available from: https://www.sheffield.ac.uk/NOGG/NOGG Guideline 2017.pdf
1. Yadav A, Carey EJ. Osteoporosis in chronic liver disease. Nutr Clin Pract. 2013;28(1):52–64.
2. Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol [Internet]. 2019;70(1):172–93. Available from: https://doi.org/10.1016/j.jhep.2018.06.024
3. Luxon BA. Bone disorders in chronic liver diseases. Curr Gastroenterol Rep. 2011;13(1):40–8.
4. Pietri M, Lucarini S. The orthopaedic treatment of fragility fractures. Clin Cases Miner Bone Metab. 2007;4(2):108–16.
5. George J, Ganesh HK, Acharya S, et al. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol. 2009;15(28):3516–22.
6. Wariaghli G, Allali F, Maghraoui A El, et al. Osteoporosis in patients with primary biliary cirrhosis. Eur J Gastroenterol Hepatol. 2010;22(12):1397–401.
7. Carey EJ, Balan V, Kremers WK, et al. Osteopenia and osteoporosis in patients with end-stage liver disease caused by hepatitis C and alcoholic liver disease: Not just a cholestatic problem. Liver Transplant. 2003;9(11):1166–73.
8. Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol [Internet]. 2019;70(1):151–71. Available from: https://doi.org/10.1016/j.jhep.2018.09.014
9. Sheron N. Alcohol and liver disease in Europe - Simple measures have the potential to prevent tens of thousands of premature deaths. J Hepatol [Internet]. 2016;64(4):957–67. Available from: http://dx.doi.org/10.1016/j.jhep.2015.11.006
10. Yoon Y, Yi H. SURVEILLANCE REPORT 83 LIVER CIRRHOSIS MORTALITY IN THE UNITED STATES , 1970 – 2005 U . S . Department of Health and Human Services Public Health Service. 2008;
11. Santos LAA, Romeiro FG. Diagnosis and Management of Cirrhosis-Related Osteoporosis. Biomed Res Int. 2016;2016.
12. López-Larramona G, Lucendo AJ, González-Castillo S, et al. Hepatic osteodystrophy: An important matter for consideration in chronic liver disease. World J Hepatol. 2011;3(12):300–7.
13. Bansal RK, Kumar M, Sachdeva PRM, et al. Prospective study of profile of hepatic osteodystrophy in patients with non-choleastatic liver cirrhosis and impact of bisphosphonate supplementation. United Eur Gastroenterol J. 2016;4(1):77–83.
14. Choudhary NS, Tomar M, Chawla YK, et al. Hepatic osteodystrophy is common in patients with noncholestatic liver disease. Dig Dis Sci. 2011;56(11):3323–7.
15. Cijevschi C, Mihai C, Zbranca E, et al. Osteoporosis in liver cirrhosis. Rom J Gastroenterol. 2005;14(4):337–41.
16. Saeki C, Takano K, Oikawa T, et al. Comparative assessment of sarcopenia using the JSH , AWGS , and EWGSOP2 criteria and the relationship between sarcopenia , osteoporosis , and osteosarcopenia in patients with liver cirrhosis. 2019;4:1–12.
17. Peris P, Parés A, Guan̄abens N, et al. Bone mass improves in alcoholics after 2 years of abstinence. J Bone Miner Res. 1994;9(10):1607–12.
18. Branco JC, Rodrigues AM, Gouveia N, et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: Results from EpiReumaPt- a national health survey. RMD Open. 2016;2(1).
19. Liang J, Meng WD, Yang JM, et al. The association between liver cirrhosis and fracture risk: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;89(4):408–13.
20. Nuti R, Brandi ML, Checchia G, et al. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med [Internet]. 2019;14(1):85–102. Available from: https://doi.org/10.1007/s11739-018-1874-2
21. Xiang BY, Huang W, Zhou GQ, et al. Body mass index and the risk of low bone mass-related fractures in women compared with men: A PRISMA-compliant meta-analysis of prospective cohort studies. Med (United States). 2017;96(12):10–5.
22. Thursz M, Gual A, Lackner C, et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol [Internet]. 2018;69(1):154–81. Available from: https://doi.org/10.1016/j.jhep.2018.03.018
23. Barrionuevo P, Kapoor E, Asi N, et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: A network meta-analysis. J Clin Endocrinol Metab. 2019;104(5):1623–30.
24. National Osteoporosis Guideline Group. NOGG 2017: Clinical Guidelines for the Prevention and Treatment of Osteoporosis. 2018;(July):1–36. Available from: https://www.sheffield.ac.uk/NOGG/NOGG Guideline 2017.pdf
Citation tools
Pereira F, Azevedo R, Linhares M, Pinto J, Leitão C, Caldeira A, et all. Hepatic osteodystrophy in cirrhosis due to alcohol-related liver disease. 7301/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1527 visits.
This article has been downloaded 247 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 28/05/2020

Accepted: 17/10/2020

Online First: 03/12/2020

Published: 28/07/2021

Article revision time: 130 days

Article Online First time: 189 days

Article editing time: 426 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology