Bone disease in patients with primary sclerosing cholangitis.
OBJECTIVE
Osteopenic bone disease occurs frequently among patients with chronic liver disease but has not been well studied in those with primary sclerosing cholangitis (PSC). We investigated the prevalence, rate of progression, and independent predictors of bone disease in a large number of patients with all stages of PSC.


METHODS
Bone mineral density of the lumbar spine, hip, and total body was measured yearly for 10 years in 237 patients with PSC.


RESULTS
Osteoporosis (T-score less than -2.5) was found in 15% of patients and occurred 23.8-fold (95% confidence interval [CI], 4.6-122.8) more frequently in those with PSC than expected from a matched population. By multivariate analysis, age 54 years or older (odds ratio [OR], 7.8; 95% CI, 3.3-18.3), body mass index ≤ 24 kg/m(2) (OR, 4.9; 95% CI, 1.9-12.6), and inflammatory bowel disease for ≥ 19 years (OR, 3.6; 95% CI, 1.5-8.4) correlated with the presence of osteoporosis. Osteoporosis was present in 75% of patients with all 3 risk factors but in only 3.1% of those without all of them. Patients with PSC lost 1% of bone mass per year; this rate of bone loss was significantly associated with duration of inflammatory bowel disease.


CONCLUSIONS
Osteoporosis occurs frequently among patients with PSC. Old age, low body mass index, and long duration of inflammatory bowel disease can be used to identify patients with PSC who might derive the most benefit from measurements of bone density and treatments for bone diseases.
Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA. paul.angulo@uky.edu
Paul
P
Angulo
Garfield A
GA
Grandison
Derek G
DG
Fong
Jill C
JC
Keach
Keith D
KD
Lindor
Einar
E
Bjornsson
Alvaro
A
Koch
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015519:Bone Density; D001847:Bone Diseases / Q000453:epidemiology*; D015209:Cholangitis, Sclerosing / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult