title: Prevalence of hepatic osteodystrophy and vitamin D deficiency in cirrhosis.
abstract: BACKGROUND
  Hepatic osteodystrophy (HO) is a major complication of cirrhosis. However, the prevalence of HO in a general cirrhotic patient population is not well defined as previous studies were in single aetiology or pre-liver transplant patients.
  
  
  OBJECTIVE
  The aims of this study were to investigate the prevalence of HO and vitamin D deficiency in patients with cirrhosis of mixed aetiology and disease severity and to determine the risk factors for HO.
  
  
  METHODS
  This is a single-centre cross-sectional study of all patients newly diagnosed with cirrhosis between September 2009 and December 2012. All patients underwent bone mineral density assessment using dual energy X-ray absorptiometry within 3 months of diagnosis. Demographic and biochemical factors, severity of underlying liver disease, previous fragility fractures, smoking status and alcohol use were collected on diagnosis. Logistic regression analysis was used to assess risk factors for HO.
  
  
  RESULTS
  Among the 406 patients (67% males), the median (range) age was 56 years (21-85) and most (84%) were Childs-Pugh A or B with a median (range) model for end-stage liver disease score of 11 (5-40). Alcohol (41%) was the most common underlying aetiology. The prevalence of HO and vitamin D deficiency (≤50 nmol/L) was 56% and 54%, respectively, and previous fragility fractures had occurred in 3%. Increasing age (odds ratio (95% confidence interval): 1.49 per 10 years (1.02-2.18), P = 0.04), excessive alcohol intake (2.34 (1.03-5.32), P = 0.04) and lower body mass index (0.92 per kg/m2 (0.87-0.98), P = 0.009) were independent risk factors for HO.
  
  
  CONCLUSIONS
  There is a high prevalence of HO and vitamin D deficiency in patients with cirrhosis at presentation irrespective of disease severity or underlying aetiology.
authors.affiliation: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Chinnaratha
authors.affiliation: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Chaudhary
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Southern Area Local Health Network, Adelaide, South Australia, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Doogue
authors.affiliation: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: McCormick
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Woodman
authors.affiliation: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.|School of Medicine, Flinders University of South Australia, Adelaide, South Australia, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Wigg
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology / Q000209:etiology*
keywords: bone disease; cirrhosis; osteopenia; osteoporosis; vitamin D deficiency