Study of the prevalence of osteopenia in Saudi patients with chronic liver disease awaiting liver transplantation

ABSTRACT

Osteoporosis is an important complication in chronic liver disease patients. This study assessed bone mineral density [BMD] in Saudi pre-transplant cirrhotic patients compared to healthy controls, evaluated its relation to gender, disease etiology and severity. We included 91 patients and 56 healthy controls [mean +/- SD age 46.1 +/- 14.8 and 55.6 +/- 12.9 years; with 45[49.5%] and 13[24.1%] were males respectively. BMD [g/cm2], Z-score [a SD from measure related to age and sex], and T-score [a SD related to peak bone mass for a young adult] of the lumbar vertebrae [L] and the femoral neck [F] were obtained using dual-photon absorptiometry. Osteoporosis was defined as a T-score of <-2.5 and osteopenia as a T- score between -1 and -2.5. Patients were significantly younger and included more males than controls p<0.001 and P<0.01 respectively. Despite that, the osteopenia calculated index was significantly higher in patients than controls [2.39 +/- 2.23 versus 1.04 +/- 1.53 respectively; p<0.01]. The mean lumbar BMD, Z-score and T-score in patients and controls were [0.91 +/- 1.6 g/cm2, -1.44 +/- 1.20 and -1.48 +/- 1.5] and [1.03 +/- 1.7, -0.24 +/- 1.1 and -0.72 +/- 1.2] respectively; p<0.001 for all. However, patients and controls had comparable femoral BMD and femoral T-score [0.84 +/- 0.1 6 g/cm2 and -1.18 +/- 1.2] and [0.85 +/- 0.13 g/cm2 and -0.88 +/- 1.1]; p= 0.51 and 0.14 respectively, but the femoral Z-score was significantly lower in patients' group [-0.73 +/- 1.1 and -0.25 +/- 1.0 for patients and controls respectively; p<0.01]. The mean MELD and Child-Pugh scores in patients were 15.1 +/- 6.4 and 9.4 +/- 2.2 respectively. Depending on the Z-score, lumbar and femoral osteopenia +/- osteoporosis in patients and controls were detected in 43[53.1%] and 24[29.3%] and 9 [16.7%] and 4[7.4%] [p<0.001 and p<0.01] respectively. Within patients, BMD was significantly less in females and in those with viral etiology compared to males and non-viral etiology [p<0.01 for both]. No correlation was detected between either the MELD score or the Child-Pugh score and lumbar or femoral BMD, T-score or Z-score. Low BMD is very common in cirrhotic patients awaiting liver transplantation irrespective of disease severity. Lower BMD is more severe in female patients and those with viral etiology. These findings necessitate early detection, proper treatment, avoidance of post-transplant steroid induction in these patients