| Background and aims:Osteoporosis is a common skeletal complication in patients with liver cirrhosis.It is usually asymptomatic,and if it is untreated,the risk of fracture could be increased and the quality of life also be impacted.Foreign research shows that liver cirrhosis is a risk factor for OP,but the incidence of osteoporosis in cirrhosis varies.There are many patients with liver cirrhosis in our country,but there is a lack of big data on the incidence of osteoporosis associated with liver cirrhosis in China.The purpose of this study is to analyze the bone mineral density(BMD)and 25(OH)D in patients with liver cirrhosis and evaluate the incidence of osteoporosis in patients with liver cirrhosis retrospectively.Methods:A total of 280 hospitalized patients with liver cirrhosis in the First Hospital of Jilin University from December 2014 to December 2016 were enrolled.There were 168 males(60%)and 112 females(40%),the age ranged from34 to 71 years old,with an average age of 55.48±9.06 years.All of them accepted bone mineral density(BMD)assessment by dual-energy X-ray absorptiometry in the lumbar spine(1-4)and bilateral femoral neck,the levels of serum 25-hydroxyvitamin D was test by liquid chromatography tandem mass spectrometry(LC-MS/MS).280 cases of patients who had no liver diseases matched by age and sex in our hospital were selected as control group.The patients are divided into primary biliary cirrhosis(PBC)group(40 cases)and non PBC group(240 cases)according to the etiology.The non PBC group includes HBV related cirrhosis group(110 cases),HCV related cirrhosis group(80 cases),alcoholic cirrhosis group(50 cases).According to the severity of liver cirrhosis,the patients were divided into group A,group B and group C according to Child-Pugh class of liver function A,B,C level.The BMD and the incidence of OP were analyzed and compared between different groups.Results:1.61 cases had osteoporosis,with the incidence rate 21.79%(61/280)in the liver cirrhosis group of 280 cases.There were 29 cases of OP and the incidence rate was osteoporosis 10.36%(29/280)in the control group.The incidence of OP in the liver cirrhosis group was significantly higher than that in the control group.In the cirrhosis group,The mean value of BMD of lumbar spine L1-4,0.757±0.154(g/cm~2),and femoral neck was 0.650±0.147(g/cm~2),which was significantly lower than that of the control group in the level of : lumbar spine L1-4 0.988±0.145(g/cm~2),femoral neck 0.843±0.153(g/cm~2).The mean value of 25-hydroxyvitamin D was 17.89±12.88(ng/ml)in the cirrhosis group,which was significantly lower than that of the control group in the level of 28.01±11.89(ng/ml)(p < 0.001).Both BMD and 25-hydroxyvitamin D levels had significant statistical differences between the two groups.2.The patients of the liver cirrhosis group were divided into group A,group B,group C according to Child-Pugh class.The lumbar bone mineral density(L1-4)were 0.843±0.169(g/cm~2),0.684±0.153(g/cm~2),0.597±0.161(g/cm~2),and the femoral neck were 0.721±0.178(g/cm~2),0.587±0.166(g/cm~2),0.501±0.158(g/cm~2)in the of group A? B and C.The BMD of patients showed a downward trend from class A to C,and BMD in class C was significantly lower than class A.The level of 25-hydroxyvitamin D in group A,B and C were 20.89±11.79(ng/ml),19.24±11.93(ng/ml),12.49±9.21(ng/ml)?The level of 25-hydroxyvitamin D of patients showed a downward trend from class A to C,and the level of 25-hydroxyvitamin D in class C was significantly lower than class A.There were 11,29,21 cases of OP from class A to class C respectively,with the incidence rates of OP 14.10%,22.31% and29.17%,and the incidence rate of OP increased from class A to class C.The rate of OP in class C was significantly higher than that of class A.3.Among the PBC patients,there were 4 males and 36 females with an average age of 56.11±11.38 years old.The incidence rate of OP was 42.50%(17/40),while in non PBC group,the incidence rate of OP was 18.33%(44/240),so the incidence rate of OP in the PBC group was significantly higher than that in the non PBC group(p=0.001).In PBC group,the BMD of lumbar(L1-4)was 0.505±0.148(g/cm~2),and femoral neck 0.424±0.132(g/cm~2),were significantly lower than that in non PBC group: L1-4: 0.799±0.149(g/cm~2),and femoral neck 0.688±0.133(g/cm~2)respectively.The mean value of 25-hydroxyvitamin D was 18.99±11.34(ng/ml)in the PBC group,which was lower than that of the non PBC group in the level of 22.79±12.98(ng/ml).But there were no statistical differences between the two groups.4.BMD of lumbar(L1-4)in the PBC group,HBV related cirrhosis group,HCV related cirrhosis group,alcoholic cirrhosis group were: 0.505±0.148(g/cm~2)?0.758±0.143(g/cm~2)?0.713±0.151(g/cm~2)?0.653±0.146(g/cm~2);and BMD of the femoral neck were 0.424±0.132(g/cm~2)?0.724±0.136(g/cm~2)?0.690±0.157(g/cm~2)?0.613±0.16(g/cm~2).There's no statistical difference of ages between different groups.The lumbar spine BMD of PBC group(L1-4)and femoral neck BMD was significantly lower than that of hepatitis B cirrhosis group ?hepatitis C cirrhosis group and alcoholic liver cirrhosis group,but there were no statistical differences within the non PBC group between each other(p > 0.05).Among the HBV related cirrhosis group,the incidence rate of OP was16.36%(18/110),while in HCV related cirrhosis group was 16.25%(13/80),and alcoholic cirrhosis group 26.00%(13/50).The incidence rate of OP had no statistical differences within the non PBC group between each other,while the incidence rate of OP in the PBC group was significantly higher than that in the HBV group(p=0.001)and HCV group(p=0.002),but there were no statistical differences between PBC group and ALD group(p=0.099).Conclusion:The levels of 25-hydroxyvitamin D and bone mineral density in patients with cirrhosis were significantly lower than those in the same age control group,and the incidence of osteoporosis was significantly higher than that in the control group.The incidence of osteoporosis increases with the aggravation of the severity of liver function in cirrhosis patients.PBC patients with cirrhosis are more likely to suffer from osteoporosis than those without PBC cirrhosis. |
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