Siqueira Mariana de Morais Lira Gouvea, Casulari Luiz Augusto, Freitas Wladimir Magalhães de, Carneiro Marcos de Vasconcelos, Mendes Liliana Sampaio Costa
Hospital de Base do Distrito Federal, Brasília, DF, Brasil.
Hospital Universitário de Brasília, Serviço de Endocrinologia, Brasília, DF, Brasil.
Arq Gastroenterol. 2022 Jan-Mar;59(1):9-15. doi: 10.1590/S0004-2803.202200001-03.
Chronic hepatic disease is associated with osteoporosis, osteopenia or osteomalacia. Osteoporosis and fractures due to bone fragility present high prevalences and are more frequent in patients with liver cirrhosis than in the general population. The search for a diagnosis of osteopenia and osteoporosis in this population may allow early intervention and modify unfavorable outcomes.
To know the prevalence of osteopenia or osteoporosis and of fracture due to bone fragility in individuals with liver cirrhosis, the associated risk factors, and its compromise in their quality of life (QoL).
Observational, transversal study performed with 71 liver cirrhosis patients of the Hepatology Service of the Hospital de Base do Distrito Federal, Brasília, DF, Brazil, between July 2017 and December 2018. The patients were submitted to bone densitometry (DXA) of the lumbar spine and of the femoral neck, to x-ray of the lumbosacral spine and to the Chronic Liver Disease Questionnaire (CLDQ) for the evaluation of quality of life (QoL). The Fracture Risk Assessment (FRAX) major was calculated for patients >50 years old. The analyses were performed for the evaluation of the risk factors associated with lumbosacral spine fracture.
The majority (62%) of the 71 evaluated patients was diagnosed with osteoporosis or osteopenia on DXA. Of the 44 patients with osteopenia or osteoporosis, 52.3% were female, with a mean age of 62.6±9.51 years old, with the majority (72.7%) being Child A, cirrhotics of alcoholic etiology (36.4%), and with an intermediate QoL according to the CLDQ (3.3). Regarding the patients with lumbosacral spine fracture, the mean age was 61.6±11.1 years old, 60% were female, most of them Child A (66.7%), of alcoholic etiology (46.7%), and with an intermediary QoL according to the CLDQ (3.5). The presence of osteopenia and/or osteoporosis was associated with lumbosacral fracture (P<0.001), without correlation with the other analyzed variables: age, body mass index, gender, presence and absence of ascites, Child-Pugh classification, vitamin D, calcium, and phosphorus serum concentration, cirrhosis etiology and FRAX major.
The prevalence of hepatic osteodystrophy was high, and the occurrence of lumbosacral spine fracture was more associated with osteoporosis and/or osteopenia among the cirrhotic patients studied. The QoL was intermediate and with no differences between cirrhotics with and without fracture.
慢性肝病与骨质疏松、骨质减少或骨软化症相关。由于骨脆性导致的骨质疏松和骨折在肝硬化患者中的患病率很高，且比普通人群更为常见。在该人群中寻找骨质减少和骨质疏松的诊断方法可能有助于早期干预并改善不良预后。
了解肝硬化患者中骨质减少或骨质疏松以及因骨脆性导致骨折的患病率、相关危险因素及其对生活质量（QoL）的影响。
2017年7月至2018年12月期间，对巴西巴西利亚联邦区基础医院肝病科的71例肝硬化患者进行了一项观察性横断面研究。患者接受了腰椎和股骨颈的骨密度测定（DXA）、腰骶椎X线检查以及用于评估生活质量（QoL）的慢性肝病问卷（CLDQ）。对年龄>50岁的患者计算骨折风险评估（FRAX）主要指标。进行分析以评估与腰骶椎骨折相关的危险因素。
71例接受评估的患者中，大多数（62%）在DXA检查中被诊断为骨质疏松或骨质减少。在44例骨质减少或骨质疏松患者中，52.3%为女性，平均年龄为62.6±9.51岁，大多数（72.7%）为Child A级，酒精性病因的肝硬化患者（36.4%），根据CLDQ评估生活质量为中等（3.3）。对于腰骶椎骨折患者，平均年龄为61.6±11.1岁，60%为女性，大多数为Child A级（66.7%），酒精性病因（46.7%），根据CLDQ评估生活质量为中等（3.5）。骨质减少和/或骨质疏松的存在与腰骶椎骨折相关（P<0.001），与其他分析变量无关：年龄、体重指数、性别、有无腹水、Child-Pugh分级、维生素D、钙和磷血清浓度、肝硬化病因和FRAX主要指标。
肝性骨营养不良的患病率很高，在所研究的肝硬化患者中，腰骶椎骨折的发生与骨质疏松和/或骨质减少的相关性更大。生活质量为中等，骨折患者与未骨折患者之间无差异。
