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Prevalence and characteristics of bone disease in cirrhotic patients under evaluation for liver transplantation.
Transplant Proc. 2012 Jul-Aug; 44(6):1496-8.TP

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%).

CONCLUSION

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+Show Affiliations

Department of Digestive Diseases, Virgen del Rocío University Hospital, Seville, Spain. alfonavsc@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22841194

Citation

Alcalde Vargas, A, et al. "Prevalence and Characteristics of Bone Disease in Cirrhotic Patients Under Evaluation for Liver Transplantation." Transplantation Proceedings, vol. 44, no. 6, 2012, pp. 1496-8.
Alcalde Vargas A, Pascasio Acevedo JM, Gutiérrez Domingo I, et al. Prevalence and characteristics of bone disease in cirrhotic patients under evaluation for liver transplantation. Transplant Proc. 2012;44(6):1496-8.
Alcalde Vargas, A., Pascasio Acevedo, J. M., Gutiérrez Domingo, I., García Jiménez, R., Sousa Martín, J. M., Ferrer Ríos, M. T., Sayago Mota, M., Giráldez Gallego, A., & Gómez Bravo, M. A. (2012). Prevalence and characteristics of bone disease in cirrhotic patients under evaluation for liver transplantation. Transplantation Proceedings, 44(6), 1496-8. https://doi.org/10.1016/j.transproceed.2012.05.011
Alcalde Vargas A, et al. Prevalence and Characteristics of Bone Disease in Cirrhotic Patients Under Evaluation for Liver Transplantation. Transplant Proc. 2012 Jul-Aug;44(6):1496-8. PubMed PMID: 22841194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and characteristics of bone disease in cirrhotic patients under evaluation for liver transplantation. AU - Alcalde Vargas,A, AU - Pascasio Acevedo,J M, AU - Gutiérrez Domingo,I, AU - García Jiménez,R, AU - Sousa Martín,J M, AU - Ferrer Ríos,M T, AU - Sayago Mota,M, AU - Giráldez Gallego,A, AU - Gómez Bravo,M A, PY - 2012/7/31/entrez PY - 2012/7/31/pubmed PY - 2013/1/4/medline SP - 1496 EP - 8 JF - Transplantation proceedings JO - Transplant. Proc. VL - 44 IS - 6 N2 - 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%). CONCLUSION: 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. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/22841194/Prevalence_and_characteristics_of_bone_disease_in_cirrhotic_patients_under_evaluation_for_liver_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(12)00442-3 DB - PRIME DP - Unbound Medicine ER -