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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 12
Dec.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(12): 2831-2838

Clinical features of bone mass loss in liver cirrhosis and its association with sarcopenia

DOI: 10.3969/j.issn.1001-5256.2023.12.013

  • Department of Gastroenterology，The Second Affiliated Hospital of Kunming Medical University，Kunming 650000，China

Research funding:

Postgraduate Innovation Fund of Kunming Medical University in 2022 (2022S275);

Hospital Clinical Research Project of The Second Affiliated Hospital of Kunming Medical University (ynllT2021012)

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  • Corresponding author: YANG Jing， yangjing_dl@ 163.com （ORCID： 0000-0003-3305-8893）
  • Received Date: 2023-03-07
  • Accepted Date: 2023-03-24
  • Published Date: 2023-12-12
    Abstract
  •   Objective  To investigate the influence of sarcopenia on bone mass loss， the risk factors for bone mass loss in liver cirrhosis， and the correlation between body composition and bone mineral density （BMD） by comparing the clinical features of bone mass loss in patients with liver cirrhosis.  Methods  A total of 92 patients who were hospitalized and diagnosed with liver cirrhosis in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from April to December of 2022 were enrolled， and based on the results of dual-energy X-ray absorptiometry， they were divided into bone mass loss group （osteopenia/osteoporosis） with 57 patients and normal bone mass group with 35 patients. The two groups were compared in terms of general data， laboratory examination， imaging data， and body composition analysis. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the continuity correction chi-square test was used for comparison of categorical data between two groups； Pearson correlation analysis and Spearman correlation analysis were used to investigate correlation； a binary logistic regression analysis was used to investigate the risk factors for bone mass loss in liver cirrhosis.  Results  Compared with the normal bone mass group， the bone mass loss group had significantly higher age （t=-3.597， P<0.05）， proportion of female patients （χ2=8.393， P<0.05）， N-terminal middle molecular fragment of osteocalcin （N-MID） （Z=-3.068， P<0.05）， β isomer of C-terminal telopeptide of type I collagen （β-CTX） （t=-2.784， P<0.05）， and proportion of patients with sarcopenia （χ2=13.884， P<0.05） and significantly lower calcitonin （CT） （Z=-2.340， P<0.05） and L3 skeletal muscle index （L3-SMI） （t=4.621， P<0.05）. Compared with the normal bone mass group， the bone mass loss group had significantly lower total muscle mass （Z=-2.952， P<0.05）， right upper limb muscle mass （Z=-2.929， P<0.05）， left upper limb muscle mass （Z=-2.680， P<0.05）， right lower limb muscle mass （Z=-3.366， P<0.05）， left lower limb muscle mass （Z=-3.374， P<0.05）， presumed bone mass （t=2.842， P<0.05）， body water mass （Z=-2.779， P<0.05）， basal metabolic rate （BMR） （Z=-3.153， P<0.05）， and BMD of L1— L4 and femoral neck （t=9.789， t=10.280， t=10.832， Z=-7.298， t=8.945， all P<0.05）. Total muscle mass， muscle mass of trunk and limbs， presumed bone mass， BMR， and body water mass in body component analysis were positively correlated with L1 — L4 BMD and femoral neck BMD （all P<0.05）， and fat mass was positively correlated with L1 — L4 BMD （all P<0.05）. Sarcopenia （odds ratio ［OR］=8.737， 95% confidence interval ［CI］： 2.237 — 34.129， P=0.002）， age （OR=1.094， 95%CI： 1.019 — 1.175， P=0.013）， and N-MID （OR=1.095， 95%CI： 1.019 — 1.176， P=0.014） were independent risk factors for bone mass loss in patients with liver cirrhosis.  Conclusion  Old age， female sex， sarcopenia， elevated N-MID， elevated β-CTX， reduction in CT， low muscle mass， low presumed bone mass， low BMR， and low body water mass are the features of bone mass loss in patients with liver cirrhosis， and sarcopenia， age， and N-MID are independent risk factors for bone mass loss in patients with liver cirrhosis. Detailed assessment of body composition changes can help to identify abnormal BMD in patients with liver cirrhosis.

     

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    • References(24)
  • [1]
    DANFORD CJ, TRIVEDI HD, BONDER A. Bone health in patients with liver diseases[J]. J Clin Densitom, 2020, 23( 2): 212- 222. DOI: 10.1016/j.jocd.2019.01.004.
    [2]
    ZHANG W, GONG H, SU ZC, et al. Risk factors associated with hepatic osteopathy in HBV related cirrhosis measured by liver stiffness: An Observational study[J]. Medicine, 2019, 98( 31): e16628. DOI: 10.1097/MD.0000000000016628.
    [3]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [4]
    Chinese Society of Osteoporosis and Bone Mineral Research. Guidelines for the diagnosis and management of primary osteoporosis(2017)[J]. Chin J Osteoporos, 2019, 25( 3): 281- 309. DOI: 10.3969/j.issn.1006-7108.2019.03.001.

    中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017)[J]. 中国骨质疏松杂志, 2019, 25( 3): 281- 309. DOI: 10.3969/j.issn.1006-7108.2019.03.001.
    [5]
    CAREY EJ, LAI JC, SONNENDAY C, et al. A North American expert opinion statement on sarcopenia in liver transplantation[J]. Hepatology, 2019, 70( 5): 1816- 1829. DOI: 10.1002/hep.30828.
    [6]
    ZHENG JP, MIAO HX, ZHENG SW, et al. Risk factors for osteoporosis in liver cirrhosis patients measured by transient elastography[J]. Medicine, 2018, 97( 20): e10645. DOI: 10.1097/MD.0000000000010645.
    [7]
    SAEKI C, TAKANO K, OIKAWA T, et al. Comparative assessment of sarcopenia using the JSH, AWGS, and EWGSOP2 criteria and the relationship between sarcopenia, osteoporosis, and osteosarcopenia in patients with liver cirrhosis[J]. BMC Musculoskelet Disord, 2019, 20( 1): 615. DOI: 10.1186/s12891-019-2983-4.
    [8]
    PERIYALWAR P, DASARATHY S. Malnutrition in cirrhosis: contribution and consequences of sarcopenia on metabolic and clinical responses[J]. Clin Liver Dis, 2012, 16( 1): 95- 131. DOI: 10.1016/j.cld.2011.12.009.
    [9]
    BENJAMIN J, SHASTHRY V, KAAL CR, et al. Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: A computed tomography based study[J]. Liver Int, 2017, 37( 11): 1668- 1674. DOI: 10.1111/liv.13509.
    [10]
    CHEN Z, LI WY, HO M, et al. The prevalence of sarcopenia in Chinese older adults: Meta-analysis and meta-regression[J]. Nutrients, 2021, 13( 5): 1441. DOI: 10.3390/nu13051441.
    [11]
    TANDON P, MONTANO-LOZA AJ, LAI JC, et al. Sarcopenia and frailty in decompensated cirrhosis[J]. J Hepatol, 2021, 75( Suppl 1): S147- S162. DOI: 10.1016/j.jhep.2021.01.025.
    [12]
    LAI JC, TANDON P, BERNAL W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American association for the study of liver diseases[J]. Hepatology, 2021, 74( 3): 1611- 1644. DOI: 10.1002/hep.32049.
    [13]
    SAEKI C, TSUBOTA A. Influencing factors and molecular pathogenesis of sarcopenia and osteosarcopenia in chronic liver disease[J]. Life, 2021, 11( 9): 899. DOI: 10.3390/life11090899.
    [14]
    ZHANG JY, TANG YM, LI JQ, et al. Risk factors for osteopenia/osteoporosis and the diagnostic value of CT value in patients with chronic hepatitis B[J]. J Clin Hepatol, 2022, 38( 5): 1041- 1047. DOI: 10.3969/j.issn.1001-5256.2022.05.013.

    张静怡, 唐映梅, 李嘉琦, 等. 慢性乙型肝炎患者骨量减少/骨质疏松的危险因素及CT值的诊断价值[J]. 临床肝胆病杂志, 2022, 38( 5): 1041- 1047. DOI: 10.3969/j.issn.1001-5256.2022.05.013.
    [15]
    PIÑAR-GUTIERREZ A, GARCÍA-FONTANA C, GARCÍA-FONTANA B, et al. Obesity and bone health: A complex relationship[J]. Int J Mol Sci, 2022, 23( 15): 8303. DOI: 10.3390/ijms23158303.
    [16]
    GKASTARIS K, GOULIS DG, POTOUPNIS M, et al. Obesity, osteoporosis and bone metabolism[J]. J Musculoskelet Neuronal Interact, 2020, 20( 3): 372- 381.
    [17]
    FAN JZ, JIANG YY, QIANG JL, et al. Associations of fat mass and fat distribution with bone mineral density in non-obese postmenopausal Chinese women over 60 years old[J]. Front Endocrinol, 2022, 13: 829867. DOI: 10.3389/fendo.2022.829867.
    [18]
    HSU WH, FAN CH, LIN ZR, et al. Effect of basal metabolic rate on the bone mineral density in middle to old age women in Taiwan[J]. Maturitas, 2013, 76( 1): 70- 74. DOI: 10.1016/j.maturitas.2013.05.016.
    [19]
    SOYSAL P, ATES BULUT E, YAVUZ I, et al. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males[J]. J Am Med Dir Assoc, 2019, 20( 1): 58- 63. DOI: 10.1016/j.jamda.2018.07.001.
    [20]
    HONG XX, QIN LQ. Analysis on characteristics of human body composition and bone mineral density in healthy middle-aged men[J]. J Community Med, 2018, 16( 18): 1385- 1388.

    洪秀秀, 秦立强. 健康中年男性人体成分和骨密度特征分析[J]. 社区医学杂志, 2018, 16( 18): 1385- 1388.
    [21]
    ZHOU XZ, SONG XY, CHEN ZH, et al. Serum type I collagen amino terminal extender peptide and type I collagen carboxyl terminal peptide β Clinical value of special sequence and 25 hydroxyvitamin D3 level in early diagnosis of diabetes induced osteoporosis[J]. Clin J Med Offic, 2023, 51( 8): 854- 856, 860. DOI: 10.16680/j.1671-3826.2023.08.22.

    周信忠, 宋晓钰, 陈治浩, 等. 血清Ⅰ型胶原氨基端延长肽、Ⅰ型胶原羧基端肽β特殊序列、25羟维生素D3水平在糖尿病性骨质疏松早期诊断中临床价值[J]. 临床军医杂志, 2023, 51( 8): 854- 856, 860. DOI: 10.16680/j.1671-3826.2023.08.22.
    [22]
    MIGLIORINI F, MAFFULLI N, SPIEZIA F, et al. Potential of biomarkers during pharmacological therapy setting for postmenopausal osteoporosis: A systematic review[J]. J Orthop Surg Res, 2021, 16( 1): 351. DOI: 10.1186/s13018-021-02497-0.
    [23]
    QU XL, ZHENG B, CHEN TY, et al. Bone turnover markers and bone mineral density to predict osteoporotic fractures in older women: A retrospective comparative study[J]. Orthop Surg, 2020, 12( 1): 116- 123. DOI: 10.1111/os.12596.
    [24]
    JIANG YP, ZHOU J, JIAO LL, et al. Predictive value of biochemical indexes of bone metabolism in patients with posthepatitic cirrhosis complicated with osteoporosis[J]. Chin J Osteoporos Bone Miner Res, 2020, 13( 4): 326- 333. DOI: 10.3969/j.issn.1674-2591.2020.04.007.

    江雅平, 周佳, 焦莉莉, 等. 骨代谢生化指标对肝炎后肝硬化并发骨质疏松的预测价值[J]. 中华骨质疏松和骨矿盐疾病杂志, 2020, 13( 4): 326- 333. DOI: 10.3969/j.issn.1674-2591.2020.04.007.
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