Cirrhosis patients face increased fracture risk
Patients with cirrhosis appear to have an elevated risk of fracture, according to a study, highlighting the importance of instituting preventive measures as early as possible.
Researchers performed a systematic review and meta-analysis of studies that examined the association between liver cirrhosis and fracture. They accessed several electronic databases for cohort or case–control studies and applied a random effects model in their analysis.
Pooled data from five cohort and three case–control studies, involving 321,035 cirrhotic individuals and 31,272 patients with fractures, showed that liver cirrhosis contributed to an increase in overall fracture risk (odds ratio [OR], 1.94; 95 percent CI, 1.59–2.37; I2=88.4 percent; p<0.001).
Increased fracture risk in patients with liver cirrhosis was also observed at the hip (OR, 2.11; 1.34–3.32), spine/trunk (OR, 2.00; 1.50–2.67) and limb (OR, 1.82; 1.65–2.01).
The underlying mechanism for the association between cirrhosis and fraction potentially involves osteoporosis, which is an important determinant for fracture. Cirrhotic patients are at risk of osteoporosis owing to hyperbilirubinaemia, corticosteroid use, physical inactivity, malnutrition, alcohol intake and impaired vitamin D absorption. [Eur J Gastroenterol Hepatol 2010;22:1397-1401]
Cognitive impairment, psychiatric illness and hepatic encephalopathy may also account for increased fracture risk in cirrhotic patients. [Osteoporos Int 2010;21:409-416; Am J Gastroenterol 2011;106:476-482]
Researchers warned that the findings should be interpreted in light of several study limitations. First, the original studies are observational in nature, and the results of which may be influenced by uncontrolled confounders and measurement errors. Second, the potential bias, confounding factors and heterogeneity among the original studies may also affect the results.
“However, care was taken to address these limitations by sensitivity analyses after excluding the largest sample size study and analysing the cohort studies and high-quality studies separately,” they said.