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.
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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
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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


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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


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