Bone disease in patients with primary sclerosing cholangitis - PubMed (original) (raw)

Bone disease in patients with primary sclerosing cholangitis

Paul Angulo et al. Gastroenterology. 2011 Jan.

Abstract

Background & aims: Osteopenic bone disease occurs frequently among patients with chronic liver disease but has not been well studied in those with primary sclerosing cholangitis (PSC). We investigated the prevalence, rate of progression, and independent predictors of bone disease in a large number of patients with all stages of PSC.

Methods: Bone mineral density of the lumbar spine, hip, and total body was measured yearly for 10 years in 237 patients with PSC.

Results: Osteoporosis (T-score less than -2.5) was found in 15% of patients and occurred 23.8-fold (95% confidence interval [CI], 4.6-122.8) more frequently in those with PSC than expected from a matched population. By multivariate analysis, age 54 years or older (odds ratio [OR], 7.8; 95% CI, 3.3-18.3), body mass index ≤ 24 kg/m(2) (OR, 4.9; 95% CI, 1.9-12.6), and inflammatory bowel disease for ≥ 19 years (OR, 3.6; 95% CI, 1.5-8.4) correlated with the presence of osteoporosis. Osteoporosis was present in 75% of patients with all 3 risk factors but in only 3.1% of those without all of them. Patients with PSC lost 1% of bone mass per year; this rate of bone loss was significantly associated with duration of inflammatory bowel disease.

Conclusions: Osteoporosis occurs frequently among patients with PSC. Old age, low body mass index, and long duration of inflammatory bowel disease can be used to identify patients with PSC who might derive the most benefit from measurements of bone density and treatments for bone diseases.

Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Figures

FIGURE 1

FIGURE 1

Decision tree using the three variables (age, body mass index, and duration of IBD) identified by multivariate analysis. The term osteoporosis refers to a t-score below −2.5

FIGURE 2

FIGURE 2

Correlation of bone mineral density of the lumbar spine (L2-L4) with (A) bone mineral density of femoral neck, and (B) bone mineral density of total body.

FIGURE 2

FIGURE 2

Correlation of bone mineral density of the lumbar spine (L2-L4) with (A) bone mineral density of femoral neck, and (B) bone mineral density of total body.

FIGURE 3

FIGURE 3

Bone mineral density of the lumbar spine (L2-L4) at baseline and at annual intervals. The continuous line refers to mean and the discontinuous line refers to standard error of the mean.

Comment in

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