Low bone mineral density score may predict risk for liver cirrhosis
Click Here to Manage Email Alerts
Key takeaways:
- Adults are less likely to develop cirrhosis with higher BMD T-scores at the femoral neck, total hip and trochanter.
- Having a BMD T-score of less than –2.5 increases the risk for cirrhosis.
Low bone mineral density may be a risk factor for developing cirrhosis, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.
In the Hong Kong Osteoporosis Study, researchers followed 7,752 adults who had BMD measured through DXA scans. After a median follow-up of 18.43 years, 42 participants developed incident cirrhosis. The risk for cirrhosis declined with each 1-point increase in BMD T-score.
“Our study sheds light on the role of bone metabolism on the development of cirrhosis,” Ching-Lung Cheung, PhD, associate professor in the department of pharmacology and pharmacy at University of Hong Kong and president of the Osteoporosis Society of Hong Kong, told Healio. “By adopting a healthy lifestyle, such as maintaining a healthy weight, following a healthy diet, avoiding alcohol and engaging in regular physical exercises, individuals can enhance not only their bone health, but also their liver health. In addition, it is also crucial for health care professionals to consider early bone health screening in individuals at risk of developing cirrhosis upon further confirmation of our findings in other populations.”
Cheung and colleagues conducted a prospective cohort study that enrolled adults living in Hong Kong from 1995 to 2010. Participants who had BMD measured at the lumbar spine, femoral neck, total hip and trochanter were included. BMD T-scores were calculated as the difference between a person’s BMD and the average BMD of young adults of the same sex and ethnicity. Incidence of cirrhosis was collected from electronic medical records. Participants were followed until incident cirrhosis, death or the end of the study on June 18, 2022.
After adjusting for covariates, each 1-point increase in BMD T-score at the femoral neck (adjusted HR = 0.56; 95% CI, 0.39-0.82; P = .002), total hip (aHR = 0.6; 95% CI, 0.44-0.82; P = .002) and trochanter (aHR = 0.63; 95% CI, 0.46-0.88; P = .006) was associated with a reduced risk for cirrhosis.
Among 6,866 adults with no known risk factors for cirrhosis at baseline, each 1-point increase in BMD T-score at the femoral neck (aHR = 0.57; 95% CI, 0.37-0.86; P = .008), total hip (aHR = 0.61; 95% CI, 0.43-0.87; P = .007) and trochanter (aHR = 0.63; 95% CI, 0.43-0.91; P = .014) lowered the risk for incident cirrhosis.
In sensitivity analysis, adults with BMD T-scores of less than –2.5 had a higher risk for developing cirrhosis than adults with BMD T-scores of greater than –1 (HR = 3.57; 95% CI, 1.15-11.09).
Cheung said the findings reveal that the interplay between bone metabolism and liver metabolism may be bidirectional. He said prior research mostly focused on how liver disease affects bone loss; however, these data reveal the need for more studies investigating how low BMD may lead to the development of cirrhosis.
“Osteoporosis could potentially contribute to liver function deterioration, and there’s the possibility that osteoporosis may occur prior to the onset of cirrhosis,” Cheung said. “They indicate the need to expand our understanding of the liver-bone axis beyond the conventional focus.”
Cheung added that studies conducted in more diverse populations are needed to validate the findings.
For more information:
Ching-Lung Cheung, PhD, can be reached at lung1212@hku.hk.
Perspective
Back to Top
Scott D. Isaacs, MD, FACE, FACP
In this prospective cohort study of adults living in Hong Kong, Cheung and colleagues found an association of higher bone mineral density with a reduced risk for cirrhosis. Osteoporosis, osteopenia and fragility fractures are the most frequent bone complications in patients with chronic liver disease. Thirty percent of patients with chronic liver disease and 55% of patients with cirrhosis have osteoporosis. Pathophysiological mechanisms that cause impaired bone quantity and quality include decreased IGF-1 production, activated immune cells, chronic inflammation, malabsorption and gut dysbiosis. Iron or copper overload from hemochromatosis or Wilson’s syndrome and toxic effects of alcohol can inhibit bone formation, and inflammatory states such as MASLD with insulin resistance or viral hepatitis can increase bone resorption.
In addition to bone loss, patients with chronic liver disease are at high risk for sarcopenia. Tri-directional crosstalk between bone, muscle and the liver mediate the development of osteosarcopenia. Metabolic impairment associated with chronic liver disease, especially cirrhosis, leads to catabolic muscle wasting from continuous breakdown of bone, muscle and adipose tissue. Upregulation of inflammatory cytokines, hyperammonemia, increased bilirubin, lower branched-chain amino acids, hypogonadism and lower IGF-1 all contribute to the development of osteosarcopenia.
Collapse
Read more about
Click Here to Manage Email Alerts