Bone Mineral Density in Patients with Nonalcoholic Steatohepatitis among End-Stage Liver Disease Patients Awaiting Liver Transplantation |
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| Institution: | 1. Endocrinology Department;2. Internal Medicine Department;3. Gastroenterology Department, Ochsner Clinic Foundation, New Orleans, Louisiana;1. Division of Endocrinology, \"V. Fazzi\" Hospital, Lecce, Italy;2. Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;3. Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy;4. Endocrine Unit & Thyroid Diseases Center, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;1. Servizio di Diabetologia, Policlinico Gemelli, Universita Cattolica, Rome, Italy;2. Global Research & Development, Novo Nordisk A/S, Søborg, Denmark;3. Practice for Internal Medicine and Diabetology, Frankfurt, Germany;4. Endocrinology, Diabetes, & Metabolism, Rambam Medical Centre and Faculty of Medicine, Technion, Haifa, Israel;5. University of Miami Miller School of Medicine, Miami, Florida;6. Department of Biostatistics & Epidemiology, Novo Nordisk A/S, Søborg, Denmark.;1. Department of Medicine;2. Division of Endocrinology and Metabolism, University of California, San Francisco, California;3. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York;4. Division of Gastroenterology, University of California, San Francisco, California |
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| Abstract: | ObjectiveSeveral studies have shown that patients with end-stage liver disease (ESLD) have lower bone mineral density (BMD) and a higher prevalence of osteoporosis compared to an age-matched population. Hyperinsulinemia and insulin resistance are typically associated with increased BMD. We hypothesized that patients with nonalcoholic steatohepatitis (NASH) and underlying insulin resistance may have higher BMD than patients with cirrhosis from other causes.MethodsWe performed a retrospective chart review of patients with ESLD who underwent liver transplant evaluation at Ochsner Clinic Foundation and had a BMD study as part of initial work up and compared BMD values of patients diagnosed with NASH to patients with cirrhosis due to other causes. Patients were categorized into 3 groups based on the etiology of their liver disease as NASH, alcoholic cirrhosis, or viral hepatitis C or B (HCV/ HBV).ResultsA total of 63 patients met the study inclusion criteria, including 15 with NASH, 17 with alcoholic cirrhosis, and 31 with HCV/HBV. The overall prevalence rates of osteopenia and osteoporosis were 44% and 12%, respectively. BMD values were higher in the NASH group than the HCV/HBV group at lumbar spine, total hip, and femoral neck (P = .01, .03, and .02, respectively). There were no statistical differences in BMD values between NASH and alcoholic cirrhosis groups at any site.ConclusionsWe found a high prevalence of low BMD among patients with ESLD awaiting liver transplantation. NASH patients had higher BMDs than HCV/ HBV patients. The effects of NASH and insulin resistance on bone are complex and should be examined further. (Endocr Pract. 2013;19:414-419) |
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