Low Bone Mass and Severity of Cholestasis Affect Fracture Risk in Patients With Primary Biliary Cirrhosis

Background & Aims

The influence of osteoporosis and liver disease on fracture risk is not well characterized in patients with primary biliary cirrhosis (PBC). We studied a large series of women with PBC to assess the prevalence and risk factors for fractures and the fracture threshold.

Methods

In female patients with PBC (n = 185; age, 55.7 ± 0.7 years; range 28–79 years), age, duration of PBC, menopausal status, and histologic stage and severity of liver disease were assessed. Vertebral and non-vertebral fractures were recorded in 170 and 172 patients, respectively. Osteoporosis and osteopenia were diagnosed based on densitometry analysis.

Results

The prevalences of vertebral, non-vertebral, and overall fractures were 11.2%, 12.2%, 20.8%, respectively. Osteoporosis was significantly more frequent in patients with PBC than in normal women. Osteoporosis was associated with age, weight, height, histologic stage, severity, and duration of liver damage; fractures were associated with osteoporosis, menopause, age, and height but not with severity of PBC. Osteoporosis was a risk factor for vertebral fracture (odds ratio [OR], 8.48; 95% confidence interval [CI]: 2.67–26.95). Lumbar T score <–1.5 (OR, 8.27; 95% CI: 1.84–37.08) and femoral neck T score <–1.5 (OR, 6.83; 95% CI: 1.48–31.63) were significant risk factors for vertebral fractures.

Conclusions

Fractures, particularly vertebral fractures, are associated with osteoporosis, osteopenia, and T scores less than –1.5, whereas osteoporosis and osteopenia are associated with the severity of liver damage. Patients with T scores less than –1.5 might require additional monitoring and be considered for therapy to prevent fractures.

Keywords: Metabolic Bone Disease, Bone Mineral Density, Osteoporosis, Osteopenia

Abbreviations used in this paper: PBC, primary biliary cirrhosis, BMD, bone mineral density