Background and Aim:
The prevalence of osteoporosis in patients with chronic liver disease (CLD) varies from 12-55% but there is a paucity of data regarding risk factors for low bone mineral density (BMD) in this group. Our study investigated the determinants of low BMD and predictors of osteoporosis in an unselected CLD non-transplant population.
Methods:
Retrospective longitudinal observational study of 98 adult CLD patients at Monash Health. Serial BMD assessment was measured by DXA at the lumbar spine (LS), total hip (TH), and femoral neck (FN). Independent predictors for BMD and osteoporosis were determined by multivariate linear and logistic regression analysis.
Results:
98 CLD patients had 267 BMD measurements over a median follow-up of 6.9 years. Median age at first DXA was 32 years (interquartile range IQR: 27-59); 74 % had cirrhosis. The aetiology of CLD included hepatitis B (22 %), followed by alcohol (21%), Hepatitis C (16%), multiple aetiologies (19%) and NASH (9%).
The baseline prevalence of osteoporosis and osteopenia at index DXA was 70% and 30%, respectively. Baseline median TH and LS T-score was -1.9 (IQR: -2.4 to -1.1) and -2.1 (IQR: -2.8 to -1.2) respectively. Twenty-eight patients developed osteoporosis during follow-up. In total, 25 patients experienced a fracture: 20 (80%) were minimal trauma.
Independent predictors of reduced total hip BMD included age, female gender and reduced BMI. Independent predictors of osteoporosis included reduced BMI and total lean mass (TLM). The presence of cirrhosis, median stiffness score on fibro scan and heavy alcohol consumption were not independently associated with osteoporosis.
Conclusion:
Our study found that low BMI and total lean mass were independent predictors of reduced BMD and increased risk of osteoporosis in a general CLD non-transplant cohort. Identifying malnutrition and sarcopenia as modifiable risk factors may allow for proactive intervention for bone health optimisation in this group.