Low bone mass and severity of cholestasis affect fracture risk in patients with primary biliary cirrhosis.
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.
Guañabens
Núria
N
Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. nguanabens@ub.edu
Cerdá
Dacia
D
Monegal
Ana
A
Pons
Francesca
F
Caballería
Llorenç
L
Peris
Pilar
P
Parés
Albert
A
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