Prevalence and prediction of osteopenia in chronic liver disease

To obtain information on the prevalence and clinical and laboratory correlates of osteopenia in patients with chronic liver disease, we measured bone densities and 30 selected laboratory variables in 133 subjects (70 men, 63 women) with liver disease. Thirty‐two had alcoholic liver disease, 18 had primary biliary cirrhosis, 16 had primary sclerosing cholangitis, 48 had other forms of cirrhosis (cryptogenic, posthepatitic) and 19 had chronic hepatitis or fibrosis without cirrhosis. Bone densities of the lumbar spine and three sites of the proximal femur (neck, Ward's triangle, greater trochanter) were estimated by dual‐photon absorptiometry. Bone densities at all sites were significantly correlated to one another (r = 0.4 to 0.9; 95% confidence intervals = 0.24–0.54 to 0.81–0.90; p < 0.0001 for all). Compared with an age‐ and gendermatched reference group, patients with liver disease had highly significant decreases in bone densities (>2 standard deviations below control values; p < 0.0008 at all sites). Decreases were particularly marked (24% to 42%) at Ward's triangle, the site of the femoral neck particularly prone to fracture. The prevalence of decreased bone densities ranged from 10% to 56%, depending on the site studied and the nature of the liver disease. Among 30 laboratory variables studied, there were significant (p < 0.05) correlations with bone densities at more than one site for urinary creatinine (r = 0.21, 0.25), urinary calcium (r = −0.18, ‐0.23), serum total alkaline phosphatase (r = −0.18, ‐0.27) and the liver‐1 isozyme of serum alkaline phosphatase (r = −0.19, ‐0.26). We conclude that osteopenia is prevalent in patients with chronic liver disease, particularly in those with reduced skeletal muscle mass (reflected in lower creatinine excretions) and higher serum alkaline phosphatases. However, because correlations are relatively low between laboratory variables and bone densities, the laboratory variables tested are not useful to predict which patients with chronic liver disease have osteopenia. Thus the way to determine the presence and severity of osteopenia in these patients is to measure bone density. (HEPATOLOGY 1990;12:273–280).