Low bone mass and severity of cholestasis affect fracture risk in patients with primary biliary cirrhosis
Open accessAbstract
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.
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Osteoporosis is frequent in PBC, although it is best regarded as a complication of the metabolic changes seen in cholestasis including reduced absorption of fat-soluble vitamins.
“Osteoporosis is frequent in PBC, although it is best regarded as a complication of the metabolic changes seen in cholestasis including reduced absorption of fat-soluble vitamins.111–113”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [111]
The Results (page unavailable) report osteoporosis in 37% of the women with PBC studied, supporting that it is frequent. The Discussion (page unavailable) links bone disease to cholestasis and mentions low vitamin D levels and calcium malabsorption, but says its pathogenesis remains unclear; it does not identify reduced absorption of fat-soluble vitamins as the mechanism. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOsteoporosis affects 20-44% of patients with PBC with the resultant risk of fragility fractures, while the majority of patients have osteopenia.
“Osteoporosis affects 20–44% of patients with PBC with the resultant risk of fragility fractures, while the majority of patients have osteopenia.111”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [111]
The Results (page unavailable) report osteoporosis in 37% of the 185 women with PBC, within the claimed 20–44% range. The Discussion (page unavailable) links low bone mass to fracture risk. The paper defines osteopenia but does not report that a majority of patients had it; its sample was also limited to women. (LLM, conf=0.88)
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- Authors
- Guañabens, N., Cerdá, D., Monegal, A., Pons, F., Caballería, L., Peris, P., & Parés, A.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Guañabens, Núria
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 138
- Issue
- 7
- Pages
- 2348-2356
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2077304786
- Cited by
- 142
- References
- 39
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 10 · 2023: 9 · 2022: 8 · 2021: 7 · 2020: 14 · 2019: 7 · 2018: 10 · 2017: 8 · 2016: 6 · 2015: 5 · 2014: 9 · 2013: 13 · 2012: 6
- FWCI
- 7.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Instituto de Salud Carlos III (FIS-08/0105)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
- Ministerio de Ciencia e Innovación
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- primary biliary cirrhosis, osteoporosis, osteopenia, fracture risk, vertebral fractures, bone mineral density, T-score, menopause, women, liver disease
- MeSH terms
- Adult, Aged, Cholestasis, Female, Humans, Liver Cirrhosis, Biliary, Middle Aged, Osteoporosis, Risk Factors, Bone Density, Prevalence, Fractures, Bone
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