Risk factors for osteoporosis in patients with end-stage liver disease

Patients with end-stage liver disease (ESLD) were evaluated and their clinical features were compared with the aim of identifying risk factors for osteoporosis. Seventy-nine patients with ESLD were enrolled in the current study. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry and compared with clinical features in patients with ESLD. BMD was identified to be significantly correlated with body mass index (r=0.430; P=0.001) and inversely correlated with total bile acid (r=-0.228; P=0.049) and urine N-telopeptide type I collagen/creatinine ratio (r=-0.280; P=0.024). Patients with osteoporosis were significantly older (osteoporosis vs. no osteoporosis, 63.0 vs. 56.0 years; P<0.05) and had higher values for total bile acid (osteoporosis vs. no osteoporosis, 306.0 vs. 129.1 µmol/l; P<0.05) and corrected calcium [osteoporosis vs. no osteoporosis, 9.85 (8.7-10.7) vs. 9.70 (8.8-10.6) mg/dl; P<0.05]. In multivariate analysis, age (β=-0.015±0.06; P=0.009) and total bile acid (β=-0.001±0.0001; P=0.041) were identified as independent factors for osteoporosis. Finally, the risk score for osteoporosis was defined as follows: Risk score=1.78-0.001 × total bile acid-(0.16 × age). The area under the receiver operating characteristic (ROC) curve risk score for osteoporosis is 0.778. Thus, the risk scores calculated in the present study may be used to predict osteoporosis in patients with ESLD.