Increased rate of bone loss at the femoral neck in patients with chronic liver disease

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Abstract
Patients with chronic liver disease (CLD) have an increased prevalence of osteoporosis. The aim of this study was to evaluate prospectively the rate of bone loss and potential predictors of increased bone loss in a cohort of patients with CLD. Bone mineral density (BMD) was measured at baseline and at follow-up by dual-energy X-ray absorptiometry at the lumbar spine and the femoral neck. Forty-three patients (31 female, 12 male) were available for a second measurement of BMD, with a median of 25 months (range 18–41) between the measurements. Mean annual bone loss at the lumbar spine and the femoral neck, respectively, was 0.6 ± 2.0% and 1.5 ± 2.4% in females and 0.8 ± 1.9% and 2.9 ± 2.0% in males. The BMD Z score decreased significantly over time at the femoral neck (P = 0.005 and P = 0.02 for females and males, respectively). Bone loss was increased significantly at the lumbar spine in patients classified as Child–Pugh B + C compared with those classified as Child–Pugh A (P = 0.04). Serum levels of bilirubin correlated independently and positively, and 25-hydroxy vitamin D3 levels negatively, with bone loss at the femoral neck. Patients with CLD have increased bone loss at the femoral neck. Advanced liver disease is associated with increased bone loss, and hyperbilirubinaemia and low levels of vitamin D3 are predictors of increased bone loss.