title: The risk of osteoporosis in patients with liver cirrhosis: a meta-analysis of literature studies.
abstract: OBJECTIVE
  Data about the association between cirrhosis and osteoporosis are contrasting. Thus, we have performed a meta-analysis of literature studies on this topic.
  
  
  METHODS
  MEDLINE, Cochrane library, EMBASE, Scopus and Web of Science databases have been searched to retrieve all articles of interest. Data on prevalence of osteoporosis, bone mineral density (BMD) and bone turnover laboratory parameters were compared among cirrhotic patients and control subjects without cirrhosis.
  
  
  METHODS
  Studies on patients with liver cirrhosis screened for the presence of osteoporosis were included.
  
  
  RESULTS
  Six case-control studies (372 cirrhotic patients and 1579 controls) were included. The prevalence of osteoporosis was higher in cirrhotic patients than in controls (34·7% vs 12·8%, OR: 2·52, 95%CI: 1·11, 5·69; P = 0·03, I(2) = 81%; P = 0·005). Accordingly, a reduced lumbar spine BMD (MD: -0·13, 95%CI: -0·24, -0·02; P = 0·02, I(2) = 93%; P < 0·00001) and z-score (MD: -1·06, 95%CI: -1·79, -0·34; P = 0·004, I(2) = 95%; P < 0·00001) were found in cirrhotic patients as compared with controls. In contrast, no significant differences were reported in femoral neck BMD and z-score. Interestingly, bone turnover laboratory parameters widely confirmed these results showing higher levels of ALP and D-Pyr, accompanied by reduced levels of IGF-1, PTH and 25-OH-D in cirrhotic patients as compared with controls.
  
  
  CONCLUSIONS
  Despite the high heterogeneity among studies, data showed an increased prevalence of osteoporosis in patients with cirrhosis. This information suggests the need of an accurate screening of bone mineral density in patients with liver cirrhosis to plan an adequate osteoporosis management.
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Roberta
authors: R
authors: Lupoli
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Alessandro
authors: A
authors: Di Minno
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Gaia
authors: G
authors: Spadarella
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Pasquale
authors: P
authors: Ambrosino
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Annalisa
authors: A
authors: Panico
authors: Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, Pagani, Italy.
authors: Luciano
authors: L
authors: Tarantino
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Gelsy
authors: G
authors: Lupoli
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors: Giovanni
authors: G
authors: Lupoli
authors: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.|Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors: Matteo Nicola Dario
authors: MN
authors: Di Minno
mesh_terms: D015519:Bone Density; D016723:Bone Remodeling; D001842:Bone and Bones / Q000378:metabolism* / Q000473:pathology; D016022:Case-Control Studies; D015897:Comorbidity; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology*; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors