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Prevalence of osteoporosis, osteopenia and vitamin d deficiency in cirrhotic patients

Kadri Atay, Ibrahim Hatemi, Emre Durcan, Tugce Eskazan, Selma Bozcan, Tuncay Sahutoglu, Billur Canbakan, Sebati Ozdemir, Murat Tuncer, Abdullah Sonsuz

Background and Aims: Osteoporosis (OP) is a major complication of cirrhosis. It can cause morbidity and mortality due to an increased fracture risk. The aim of this study is to determine the frequency of OP and vitamin D deficiency among patients with cirrhosis and to identify the risk factors associated with OP in these patients.

Methods: A single center retrospective study of the patients diagnosed with cirrhosis between January 2010 and January 2015 who were underwent Bone Mineral Density assessment using dual energy X-ray absorptiometry in 3 months from the diagnosis of cirrhosis. Demographic and biochemical factors, severity of underlying liver disease, history of fragility fracture, smoking status and alcohol use were collected from the patient file. Multivariate binary logistic regression analyses were used to assess risk factors for OP.

Results: Among the 126 patients (Male/Female, 55%/45%, median (range) age: 56 ± 13 (20-87) years), most (47.6%) were Child-Pugh A. The most common causes of cirrhosis were cryptogenic and hepatitis B was (37% and 34 % respectively). The prevalence of OP and osteopenia and vitamin D deficiency was 31% and 36% and 84.9% respectively. Previous fragility fractures had occurred in 6.3%. In multivariate logistic regression analysis (r2 of the model was 0.18) revealed that female sex (OR (95% CI): 2.8 (1.096-7.15), p=0.03) and older age (OR (95% CI): 1.039 (1.003-1.076), p=0.03) were independent predictors of OP. Lower BMI (OR (95% CI): 0.91(0.836-1.008), p=0.06) tended to have an independent association with OP.

Conclusions: Osteoporosis and vitamin D deficiency are common metabolic complications in patients with chronic liver diseases. More than one fourth of our cirrhotic patients had osteoporosis, and 6.3% had a history of fracture. This study suggests the need of an accurate screening of bone mineral density in patients with liver cirrhosis to plan an adequate osteoporosis management.