title: Low body mass index and use of corticosteroids, but not cholestasis, are risk factors for osteoporosis in patients with chronic liver disease.
abstract: OBJECTIVE
  Metabolic bone disease is known to complicate chronic liver disease. In a cross-sectional, controlled study we have studied the prevalence of osteoporosis in patients with various types of chronic liver disease. We also identified risk factors predisposing to osteoporosis in this patient group.
  
  
  METHODS
  Seventy-two hospitalised patients, 46 females and 26 males, were included. Age- and sex-matched individuals from the background population served as controls. Bone mineral density was measured by dual energy X-ray absorptiometry at the lumbar spine and femoral neck.
  
  
  RESULTS
  Bone mineral density was significantly lower in patients with chronic liver disease than in controls at the lumbar spine (Z-score: -0.35 SD+/-1.36 vs. 0.26 SD+/-1.19, p<0.01) but not at the femoral neck (Z-score: -0.18 SD+/-1.48 vs. 0.17 SD+/-1.08, NS). Patients with cholestatic chronic liver disease did not have lower bone mineral density compared with patients with non-cholestatic chronic liver disease (Z-score: -0.35 SD+/-1.30 vs. -0.34 SD+/-1.45). Osteoporosis was found in 30% of the patients and 15% of the controls, respectively. In a multivariate regression analysis on risk factors in the patient group, the following factors were associated with osteoporosis: use of corticosteroids (odds ratio=18.9; p<0.01), low body mass index (odds ratio=14.1; p=0.001), high age and female sex.
  
  
  CONCLUSIONS
  Patients with chronic liver disease are at risk of developing osteoporosis. Risk factors for osteoporosis in chronic liver disease are low body mass index and corticosteroid therapy, in addition to high age and female sex. Cholestatic liver disease per se is not associated with an increased risk for osteoporosis.
authors.affiliation: Department of Internal Medicine, University Hospital, Uppsala, Sweden. sif.ormarsdottir@medicin.uu.se
authors.forename: S
authors.initials: S
authors.lastname: Ormarsdóttir
authors.forename: O
authors.initials: O
authors.lastname: Ljunggren
authors.forename: H
authors.initials: H
authors.lastname: Mallmin
authors.forename: H
authors.initials: H
authors.lastname: Brahm
authors.forename: L
authors.initials: L
authors.lastname: Lööf
mesh_terms: D015502:Absorptiometry, Photon; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D015992:Body Mass Index; D015519:Bone Density; D002779:Cholestasis / Q000150:complications*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005269:Femur; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008593:Menopause; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013131:Spine; D013851:Thinness
chemical_list: D000305:Adrenal Cortex Hormones