title: Low bone mass and severity of cholestasis affect fracture risk in patients with primary biliary cirrhosis.
abstract: OBJECTIVE
  The influence of osteoporosis and liver disease on fracture risk is not well characterized in patients with primary biliary cirrhosis (PBC). We studied a large series of women with PBC to assess the prevalence and risk factors for fractures and the fracture threshold.
  
  
  METHODS
  In female patients with PBC (n = 185; age, 55.7 +/- 0.7 years; range 28-79 years), age, duration of PBC, menopausal status, and histologic stage and severity of liver disease were assessed. Vertebral and non-vertebral fractures were recorded in 170 and 172 patients, respectively. Osteoporosis and osteopenia were diagnosed based on densitometry analysis.
  
  
  RESULTS
  The prevalences of vertebral, non-vertebral, and overall fractures were 11.2%, 12.2%, 20.8%, respectively. Osteoporosis was significantly more frequent in patients with PBC than in normal women. Osteoporosis was associated with age, weight, height, histologic stage, severity, and duration of liver damage; fractures were associated with osteoporosis, menopause, age, and height but not with severity of PBC. Osteoporosis was a risk factor for vertebral fracture (odds ratio [OR], 8.48; 95% confidence interval [CI]: 2.67-26.95). Lumbar T score <-1.5 (OR, 8.27; 95% CI: 1.84-37.08) and femoral neck T score <-1.5 (OR, 6.83; 95% CI: 1.48-31.63) were significant risk factors for vertebral fractures.
  
  
  CONCLUSIONS
  Fractures, particularly vertebral fractures, are associated with osteoporosis, osteopenia, and T scores less than -1.5, whereas osteoporosis and osteopenia are associated with the severity of liver damage. Patients with T scores less than -1.5 might require additional monitoring and be considered for therapy to prevent fractures.
authors.affiliation: Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. nguanabens@ub.edu
authors.forename: Núria
authors.initials: N
authors.lastname: Guañabens
authors.forename: Dacia
authors.initials: D
authors.lastname: Cerdá
authors.forename: Ana
authors.initials: A
authors.lastname: Monegal
authors.forename: Francesca
authors.initials: F
authors.lastname: Pons
authors.forename: Llorenç
authors.initials: L
authors.lastname: Caballería
authors.forename: Pilar
authors.initials: P
authors.lastname: Peris
authors.forename: Albert
authors.initials: A
authors.lastname: Parés
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density; D002779:Cholestasis / Q000150:complications*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors