title: The factors affecting bone density in cirrhosis.
abstract: BACKGROUND
  Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.
  
  
  OBJECTIVE
  We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it.
  
  
  METHODS
  In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m(2) were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.
  
  
  CONCLUSIONS
  Abnormal DEXA was highly prevalent among patients with cirrhosis. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function.
authors.affiliation: Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Asghar
authors.initials: A
authors.lastname: Hajiabbasi
authors.affiliation: Gasteroenterology and Liver Disease Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Afshin
authors.initials: A
authors.lastname: Shafaghi
authors.affiliation: Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Haniyeh Sadat
authors.initials: HS
authors.lastname: Fayazi
authors.affiliation: Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Irandokht
authors.initials: I
authors.lastname: Shenavar Masooleh
authors.affiliation: Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Hedayati Emami
authors.affiliation: Guilan Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Pooneh
authors.initials: P
authors.lastname: Ghavidel Parsa
authors.affiliation: Student Research Center, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Amir Maafi
keywords: Bone Density; Liver Cirrhosis; Osteoporosis