The HOPeFUL Study: Hepatic Osteodystrophy Prevalence and Contributory Factors Unveiling Study

Introduction: Cirrhosis, characterized by liver fibrosis and architectural distortion, significantly impairs multiple liver functions, including skeletal health. Advances in cirrhosis management have increased survival, highlighting the need to address extrahepatic manifestations such as osteoporosis. Vitamin D metabolism, heavily reliant on liver function, plays a crucial role in bone health, with liver disease often leading to severe vitamin D deficiency and abnormal calcium metabolism. Methods: This cross-sectional observational study was conducted at a tertiary care hospital in Western India over two years to assess the prevalence of hepatic osteodystrophy (HOD) in cirrhotic patients. Adult patients with clinical and/or imaging evidence of cirrhosis were recruited, excluding those with known risk factors. Relevant clinical history, physical examination, and laboratory investigations were performed. Bone mineral density (BMD) was assessed at the lumbar spine and hip using dual-energy X-ray absorptiometry (DEXA), with results expressed as T-scores. Data were analyzed using appropriate Statistical Software, employing appropriate statistical tests for continuous and categorical variables, with a significance threshold of P < 0.05. Results: The prevalence of osteoporosis and osteopenia in cirrhotic patients was 29.2% and 28.3%, respectively, with a combined HOD prevalence of 57.5%. Significant associations were found with smoking ( P = 0.002), steroid use ( P = 0.007), and lack of vitamin D supplementation ( P < 0.0001). Low serum vitamin D levels were notably linked to osteoporosis (87.5%). Even with adequate vitamin D, many patients exhibited osteopenia or osteoporosis, indicating other contributing factors. Significant correlations were observed between T-scores and cirrhosis severity (Child-Pugh and MELD-Na scores). Conclusion: The study confirms a high prevalence of HOD in cirrhotic patients. Despite adequate vitamin D levels, the persistence of bone disorders suggests further research into additional contributing factors and prospective controlled trials to understand the impact of vitamin D supplementation and other modifiable risks, like smoking and prior use of steroids, in cirrhotic patients.