title: The impact of fragility fractures on health-related quality of life in patients with primary sclerosing cholangitis.
abstract: BACKGROUND
  Osteoporosis occurs frequently in patients with chronic cholestatic liver diseases, yet data are scarce regarding the prevalence of osteoporosis and fragility fractures and their impact on Health-Related Quality of Life (HRQoL) in Primary Sclerosing Cholangitis (PSC).
  
  
  OBJECTIVE
  We aimed to assess Bone Mineral Density (BMD), physical activity and incidence of fragility fractures in patients with PSC. We also sought associations between prior fractures and HRQoL.
  
  
  METHODS
  The study was performed on 33 patients (11 females, 22 males) aged 35.3 ± 13 years. HRQoL was assessed by Short Form (SF)-36, Primary Biliary Cirrhosis (PBC)-40 and PBC-27 questionnaires. BMD was measured by densitometry in the lumbar spine and hip. Physical activity was assessed by questionnaire.
  
  
  RESULTS
  In 32% of patients, BMD measured in the hip or spine was below 1.0 Standard Deviation. A history of fragility fractures (distal forearm and ribs) was reported in six patients (18%). In SF-36 assessment, patients with fractures had lower scores in the role functioning, general health and vitality domains and Physical Component Summary (PCS) than those without fractures. Prior fractures adjusted for gender and PSC duration were associated with lower PCS and Mental Component Summary (MCS) scores. Symptoms and fatigue (assessed by PBC) and prior fractures were inversely associated with MCS (P = 0.007).
  
  
  CONCLUSIONS
  In middle-aged subjects with PSC, we found a high rate of non-vertebral fractures and a moderately decreased BMD in lumbar spine and hip. Fragility fractures had an impact on physical and mental aspects of HRQoL.
authors.affiliation: Hepatology and Internal Medicine Unit, Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Raszeja-Wyszomirska
authors.affiliation: Liver Research Laboratories, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Kucharski
authors.affiliation: Hepatology and Internal Medicine Unit, Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Zygmunt
authors.affiliation: Department of Biochemistry and Chemistry, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Safranow
authors.affiliation: Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miazgowski
keywords: Cholangitis, Sclerosis; Health; Osteoporosis; Quality of Life