Bone Mineral Density in Chronic Liver Disease Patients: High Prevalence of Osteopenia and Osteoporosis in Patients of Advanced Cirrhosis

Abstract Background: Hepatic osteodystrophy is a well-known metabolic bone complication in individuals with chronic liver disease (CLD). The pathophysiology is unknown, and evidence of increased risk of osteoporosis and osteopenia in CLD is inconsistent. Objective: The present study aims to describe the bone mineral density in CLD patients and explore its association with the severity of liver disease. Materials and Methods: Sixty patients with confirmed liver cirrhosis were enrolled in this study. All patients underwent laboratory measurements and bone mineral densitometry (BMD) using dual X-ray absorptiometry. Results: Low BMD was found in 43 (71.66%) of patients, and only 17 (28.33%) patients had normal BMD. The causes of CLD were hepatitis B in 12 (20%) patients, hepatitis C in 11 (18.33%), and cryptogenic in 37 (61.66%) patients. Out of 43 patients, 26 (43.33%) had osteopenia and 17 (28.33%) had osteoporosis. A statistically significant difference was found between normal BMD patients and low bone marrow density (BMD) patients in terms of calcium and bilirubin levels. Low BMD patients had low serum calcium and high bilirubin levels as compared to those with normal BMD. Bone mineral density worsens with worsening of cirrhosis (Child C [ n = 14/14, 100%], Child B [ n = 17/19, 89%], and Child A [ n = 12/27, 45%]). Conclusion: The study showed that low BMD is highly prevalent in individuals with CLD of variable etiologies. Bone density worsens as the liver disease progresses and directly correlates with Child–Turcotte–Pugh (CTP) score. Due to its high prevalence, these patients should undergo routine bone densitometry assessment and if required, to be treated for osteopenia and osteoporosis before their CTP score worsens.