Risk factors for osteoporosis in patients with end-stage liver disease

Uchida,Shinjiro; Miyaaki,Hisamitsu; Ichikawa,Tatsuki; Taura,Naota; Miuma,Satoshi; Honda,Takuya; Shibata,Hidetaka; Haraguchi,Masafumi; Senoo,Takemasa; Nakao,Kazuhiko

doi:10.3892/br.2016.764

Risk factors for osteoporosis in patients with end-stage liver disease

Authors:
- Shinjiro Uchida
- Hisamitsu Miyaaki
- Tatsuki Ichikawa
- Naota Taura
- Satoshi Miuma
- Takuya Honda
- Hidetaka Shibata
- Masafumi Haraguchi
- Takemasa Senoo
- Kazuhiko Nakao
View Affiliations

Affiliations: Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852‑8501, Japan
Published online on: September 29, 2016 https://doi.org/10.3892/br.2016.764
Pages: 629-633

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Patients with end-stage liver disease (ESLD) were evaluated and their clinical features were compared with the aim of identifying risk factors for osteoporosis. Seventy‑nine patients with ESLD were enrolled in the current study. Bone mineral density (BMD) was assessed by dual‑energy X‑ray absorptiometry and compared with clinical features in patients with ESLD. BMD was identified to be significantly correlated with body mass index (r=0.430; P=0.001) and inversely correlated with total bile acid (r=‑0.228; P=0.049) and urine N‑telopeptide type I collagen/creatinine ratio (r=‑0.280; P=0.024). Patients with osteoporosis were significantly older (osteoporosis vs. no osteoporosis, 63.0 vs. 56.0 years; P<0.05) and had higher values for total bile acid (osteoporosis vs. no osteoporosis, 306.0 vs. 129.1 µmol/l; P<0.05) and corrected calcium [osteoporosis vs. no osteoporosis, 9.85 (8.7‑10.7) vs. 9.70 (8.8‑10.6) mg/dl; P<0.05]. In multivariate analysis, age (β=‑0.015±0.06; P=0.009) and total bile acid (β=‑0.001±0.0001; P=0.041) were identified as independent factors for osteoporosis. Finally, the risk score for osteoporosis was defined as follows: Risk score=1.78‑0.001 x total bile acid-(0.16 x age). The area under the receiver operating characteristic (ROC) curve risk score for osteoporosis is 0.778. Thus, the risk scores calculated in the present study may be used to predict osteoporosis in patients with ESLD.

View Figures

View References

1	Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K and Akune T: Cohort profile: Research on osteoarthritis/osteoporosis against disability Study. Int J Epidemiol. 39:988–995. 2010. View Article : Google Scholar : PubMed/NCBI
2	Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, et al: Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: The research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab. 27:620–628. 2009. View Article : Google Scholar : PubMed/NCBI
3	Goel V and Kar P: Hepatic osteodystrophy. Trop Gastroenterol. 31:82–86. 2010.PubMed/NCBI
4	Bonkovsky HL, Hawkins M, Steinberg K, Hersh T, Galambos JT, Henderson JM, Millikan WJ and Galloway JR: Prevalence and prediction of osteopenia in chronic liver disease. Hepatology. 12:273–280. 1990. View Article : Google Scholar : PubMed/NCBI
5	Goral V, Simsek M and Mete N: Hepatic osteodystrophy and liver cirrhosis. World J Gastroenterol. 16:1639–1643. 2010. View Article : Google Scholar : PubMed/NCBI
6	Herlong HF, Recker RR and Maddrey WC: Bone disease in primary biliary cirrhosis: Histologic features and response to 25-hydroxyvitamin D. Gastroenterology. 83:103–108. 1982.PubMed/NCBI
7	Parés A and Guañabens N: Oste-oporosis in primary biliary cirrhosis: Pathogenesis and treatment. Clin Liver Dis. 12:407–424. 2008. View Article : Google Scholar : PubMed/NCBI
8	Peris P, Guañabens N, Parés A, Pons F, del Rio L, Monegal A, Surís X, Caballería J, Rodés J and Muñoz-Gómez J: Vertebral fractures and osteopenia in chronic alcoholic patients. Calcif Tissue Int. 57:111–114. 1995. View Article : Google Scholar : PubMed/NCBI
9	No authors listed, . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 843:1–129. 1994.PubMed/NCBI
10	Mounach A, Ouzzif Z, Wariaghli G, Achemlal L, Benbaghdadi I, Aouragh A, Bezza A and El Maghraoui A: Primary biliary cirrhosis and osteoporosis: A case-control study. J Bone Miner Metab. 26:379–384. 2008. View Article : Google Scholar : PubMed/NCBI
11	Santolaria F, González-Reimers E, Pérez-Manzano JL, Milena A, Gómez-Rodríguez MA, González-Díaz A, de la Vega MJ and Martínez-Riera A: Osteopenia assessed by body composition analysis is related to malnutrition in alcoholic patients. Alcohol. 22:147–157. 2000. View Article : Google Scholar : PubMed/NCBI
12	Hofmann AF: The enterohepatic circulation of bile acids in manThe Hepatobiliary System. Taylor W: Springer Science and Business Media; NY: pp. 517–527. 1976, View Article : Google Scholar
13	Kitson MT and Roberts SK: D-livering the message: The importance of vitamin D status in chronic liver disease. J Hepatol. 57:897–909. 2012. View Article : Google Scholar : PubMed/NCBI
14	Tsiaras WG and Weinstock MA: Factors influencing vitamin D status. Acta Derm Venereol. 91:115–124. 2011. View Article : Google Scholar : PubMed/NCBI
15	Ackerman Z, Weinreb M, Amir G and Pollak RD: Bone mineral metabolism and histomorphometry in rats with cholestatic liver disease. Liver. 22:166–172. 2002. View Article : Google Scholar : PubMed/NCBI
16	Delmas PD, Eastell R, Garnero P, Seibel MJ and Stepan J: Committee of Scientific Advisors of the International Osteoporosis Foundation: The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int. 11(Suppl 6): S2–S17. 2000. View Article : Google Scholar : PubMed/NCBI
17	Sone T and Fukunaga M: Prevalence of osteoporosis in Japan and the international comparison. Nihon Rinsho. 62(Suppl 2): 197–200. 2004.(In Japanese). PubMed/NCBI
18	Sokhi RP, Anantharaju A, Kondaveeti R, Creech SD, Islam KK and Van Thiel DH: Bone mineral density among cirrhotic patients awaiting liver transplantation. Liver Transpl. 10:648–653. 2004. View Article : Google Scholar : PubMed/NCBI
19	Ninkovic M, Skingle SJ, Bearcroft PW, Bishop N, Alexander GJ and Compston JE: Incidence of vertebral fractures in the first three months after orthotopic liver transplantation. Eur J Gastroenterol Hepatol. 12:931–935. 2000. View Article : Google Scholar : PubMed/NCBI
20	Monegal A, Navasa M, Guañabens N, Peris P, Pons F, de Osaba MJ Martinez, Rimola A, Rodés J and Muñoz-Gómez J: Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation. Calcif Tissue Int. 60:148–154. 1997. View Article : Google Scholar : PubMed/NCBI
21	Guañabens N, Parés A, Ros I, Caballería L, Pons F, Vidal S, Monegal A, Peris P and Rodés J: Severity of cholestasis and advanced histological stage but not menopausal status are the major risk factors for osteoporosis in primary biliary cirrhosis. J Hepatol. 42:573–577. 2005. View Article : Google Scholar : PubMed/NCBI
22	Leslie WD, Bernstein CN and Leboff MS: American Gastroenterological Association Clinical Practice Commitee: AGA technical review on osteoporosis in hepatic disorders. Gastroenterology. 125:941–966. 2003. View Article : Google Scholar : PubMed/NCBI
23	Angulo P, Therneau TM, Jorgensen A, DeSotel CK, Egan KS, Dickson ER, Hay JE and Lindor KD: Bone disease in patients with primary sclerosing cholangitis: Prevalence, severity and prediction of progression. J Hepatol. 29:729–735. 1998. View Article : Google Scholar : PubMed/NCBI