Relation of bone mineral density with severity of liver cirrhosis


  • P. D. Meena Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Amandeep Singh Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • C. L. Nawal Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Radhey Shyam Chejara Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Swapnil Jain Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
  • Pradeep Kumar Bansal Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India



BMD, Cirrhosis, Liver cirrhosis, Osteoporosis


Background: Osteoporosis is commonly associated with chronic liver disease. Pathologic fracture in osteoporotic patients affects quality of life as well as decrease life expectancy. Around 40% of patients with chronic liver disease may experience osteoporotic fracture. The present study was undertaken to observe the relation of bone mineral density (BMD) with severity of liver cirrhosis along with effects of smoking and alcohol.

Methods: A total of 187 liver cirrhosis patients who were admitted in SMS Hospital were taken for study and were classified into class A, B, C as per Child Turcot Pugh’s classification, after applying inclusion and exclusion criteria. All patients underwent standard laboratory testing and bone densitometric studies of the lumbar spine using dual X-ray absorptiometry (DEXA) scan. Statistical analysis done.

Results: The bone mineral density was significantly low in Class C. Class C have 41 patients of osteoporosis out of 62 whereas only 16 patients have osteoporosis in Class B and only 1 case of osteoporosis in class A. Hypocalcemia and hypophosphatemia were more in class C as in comparison to class A and B. Also, chronic smoking and alcohol intake were strongly associated with the severity of cirrhosis.

Conclusions: The prevalence of osteopenia and osteoporosis is higher in cirrhotic patients and significantly increases with severity. Hypocalcemia and hypophosphatemia are also associated with the cirrhosis. Thus, patients should undergo routine bone densitometry assessment and, if necessary, to be treated for osteoporosis


Handzlik-Orlik G, Holecki M, Wilczyński K, Duława J. Osteoporosis in liver disease: pathogenesis and management. Ther Adv Endocrinol Metab. 2016;7(3):128-35.

Compston JE. Hepatic osteodystrophy: vitamin D metabolism in patients with liver disease. Gut 1986;27(9):1073-90.

Stellon AJ, Webb A, Compston J, Williams R. Low bone turnover state in primary biliary cirrhosis. Hepatol. 1987;7:137-42.

Guanabens N, Pares A, Marinoso L, Brancos MA, Piera C, Serrano S, et al. Factors influencing the development of metabolic bone disease in primary biliary cirrhosis. Am J Gastroenterol 1990;85(10):1356-62.

Głuszko P, Lorenc RS, Karczmarewicz E, Misiorowski W, Jaworski M, et al. Working Group including the representatives of the Polish Associations of Orthopedics and Traumatology, Rehabilitation, Gerontology, Rheumatology, Family Medicine, Diabetology, Laboratory Diagnostics, Andropause and Menopause, Endocrinology, Radiology, and the STENKO group. Pol Arch Med Wewn. 2014; 124(5):255-63.

Dempster DW, Lindsay R. Pathogenesis of osteoporosis. Lancet. 1993;341(8848):797-801.

Boulton-Jones JR, Fenn RM, West J, Logan RF, Ryder SD. Fracture risk of women with primary biliary cirrhosis: no increase compared with general population controls. Aliment Pharmacol Ther. 2004;20(5):551-7.

Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G. Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol. 2001;96(7):2199-2205.

Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, et al. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterol. 2001;120(1):170-8.

Alam MA, Ahmed N, Alam S, Al Mahtab M. Study of correlation of severity of hepatic cirrhosis with severity of bone changes measured by BMD (Bone Mineral Density). Bangladesh J Med. 2013;22(2):41-6.

Hara M1, Tanaka K, Sakamoto T, Higaki Y, Mizuta T, Eguchi Y, et al. Case–control study on cigarette smoking and the risk of hepatocellular carcinoma among Japanese. Cancer Sci. 2008;99(1):93-7.

Mukherjee PS, Vishnubhatla S, Amarapurkar DN, Das K, Sood A, Chawla YK, et al. Etiology and mode of presentation of chronic liver diseases in India: a multi centric study. PloS one. 2017;12(10):e0187033.

Bin S, Min-zhang, Z. A clinical study on hypocalcemia in patients with liver cirrhosis. J Presentnal of Tongji University (Medical Science). 2004-03:129.

Long RG, Varghese Z, Skinner RK, Wills MR, Sherlock S. Phosphate metabolism in chronic liver disease. Clinica Chimica Acta. 1978;87(3):353-8.

Turkeli M, Dursun H, Albayrak F, Okçu N, Uyanik MH, Uyanik A, et al. Effects of cirrhosis on bone mineral density and bone metabolism. Euras J Med. 2008;40(1):18.

Sokhi RP, Anantharaju A, Kondaveeti R, Creech SD, Islam KK, et al. Bone mineral density among cirrhotic patients awaiting liver transplantation. Liver Transpl. 2004;10(5):648-53.

Cijevschi C, Mihai C, Zbranca E, Gogalniceanu P. Osteoporosis in liver cirrhosis. Rom J Gastroenterol. 2005;14(4):337-41.






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