title: Prevalence and characteristics of bone disease in cirrhotic patients under evaluation for liver transplantation.
abstract: BACKGROUND
  We performed a retrospective study to examine the prevalence of bone disease (BD) among cirrhotic patients being evaluated for liver transplantation (OLT) using bone densitometry dual-energy x-ray absorptiometry in the hip/femoral neck and lumbar spine. The associations of BD with demographic and clinical data, disease etiology and liver function were studied by univariate and multivariate logistic regression analyses. Osteopenia and osteoporosis were defined by World Health Organization criteria.
  
  
  RESULTS
  We included 486 patients (79% men of mean age, 53 ± 8.8 years (range, 21-69) who included 62.6% smoker and 23.7% diabetic subjects. Body mass index (BMI) was 28.8 ± 5.7 kg/m(2) (range, 16-43). The liver disease was Child-Pugh class A (22%), B (51%), or C (27%); the Model for End-Stage Liver Disease (MELD) score was 14.6 ± 5.4 (range, 7-33). The disease etiology was alcohol (59%), hepatitis C (32%), hepatitis B (10%), primary biliary cirrhosis (PBC) (2.3%), secondary biliary cirrhosis, (2%) or other causes (10%). In all, 350 patients (72%) had BD in the hip/femoral neck and/or lumbar spine: Global hip, 26% (osteopenia, 22%; osteoporosis, 4%); femoral neck, 48% (osteopenia, 43%; osteoporosis, 5%) and lumbar spine, 63% (osteopenia, 40%; osteoporosis, 23%). Univariate analysis showed the BD risk to increase with the following variables: Female gender (odds ratio [OR], 1.88; P = .023) and lower BMI (OR, 0.95; P = .012). Upon multivariate analysis, female gender (OR, 2.43; P = .004), lower BMI (OR, 0.96; P = .016), and tobacco use (OR, 1.59; P = .043) were significant. PBC showed BD in 100% of cases. By adjusting bone mineral density (BMD) values to age (Z-score) in relation to that defined by T-score, we observed a decrease in BD prevalence in both the femoral neck (20% vs 48%) and the lumbar spine (44% vs 63%).
  
  
  CONCLUSIONS
  BD, especially in the lumbar spine, is common among cirrhotic patients under evaluation for OLT. Cirrhosis is a major BD risk factor that remains even when BMD values are adjusted for age. Female gender, lower BMI, and tobacco consumption are major risk factors for BD in cirrhotic patients. Bone densitometry must be included in the OLT evaluation of all patients.
authors: Department of Digestive Diseases, Virgen del Rocío University Hospital, Seville, Spain. alfonavsc@hotmail.com
authors: A
authors: A
authors: Alcalde Vargas
authors: J M
authors: JM
authors: Pascasio Acevedo
authors: I
authors: I
authors: Gutiérrez Domingo
authors: R
authors: R
authors: García Jiménez
authors: J M
authors: JM
authors: Sousa Martín
authors: M T
authors: MT
authors: Ferrer Ríos
authors: M
authors: M
authors: Sayago Mota
authors: A
authors: A
authors: Giráldez Gallego
authors: M A
authors: MA
authors: Gómez Bravo
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D055815:Young Adult