| Objective(s): Bone mass loss(osteoporosis/osteopenia)is a common complication of cirrhosis and affects the quality of life and long-term prognosis of patients.At present,the pathogenesis and risk factors of bone mass loss in cirrhosis are not clear,and the treatment is mainly based on the treatment of primary osteoporosis.Bone,muscle and fat are the main composition of the human body.Studies have shown that sarcopenia may be related to bone mass loss,and body composition may be related to bone mineral density(BMD).In order to provide ideas for the prevention and treatment of bone mass loss in patients with cirrhosis,this study explored the correlation between sarcopenia and bone mass loss,the risk factors of bone mass loss,and the correlation between body composition analysis and BMD in patients with cirrhosis by comparing the clinical characteristics of bone mass loss in patients with cirrhosis.Methods: A total of 92 patients with cirrhosis who hospitalized in the Department of Gastroenterology of our hospital from April 2022 to December 2022 were selected in the study.The patients were divided into bone mass loss group(osteopenia/osteoporosis)with 57 patients and normal bone mass group with 35 patients according to dual-energy X-ray absorptiometry(DXA).The differences in general data,laboratory data,subcutaneous adipose tissue area and visceral adipose tissue area at umbilical level,body composition analysis,BMD of the first lumbar spine to the fourth lumbar spine,BMD of the femoral neck,skeletal muscle index(L3-SMI)of the third lumbar spine and sarcopenia were compared between the two groups.General information included age,sex,BMI,grip strength,etiology of cirrhosis,Child-Pugh grade and history of hormone use,tenofovir disoproxil fumarate use,smoking,alcohol,hypertension,and diabetes.Laboratory indicators included albumin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyltransferase(GGT),cholinesterase,total bilirubin,total cholesterol(TC),triglyceride(TG),calcium,phosphorus,coagulation function,25 hydroxyvitamin D,β-cross-linked C-terminal telopeptide of type I collagen(β-CTX),N-terminal middle molecular fragment of osteocalcin(N-MID),parathyroid hormone(PTH),calcitonin(CT).Logistic regression was used to analyze the independent risk factor for bone mass loss in patients with cirrhosis,and ROC curve was drawn to evaluate the predictive value of predictors for bone mass loss in patients with cirrhosis.Correlation analysis was used to analyze the correlation between body composition and L1-L4 BMD and femoral neck BMD.Results:1.Compared with the normal bone mass group,the bone mass loss group had significantly higher levels of age,female proportion,N-MID and β-CTX(P<0.05)and had significantly lower level of CT(P<0.05).2.The total muscle mass,right upper limb muscle mass,left upper limb muscle mass,right lower limb muscle mass,left lower limb muscle mass,bone mass,body water mass,basal metabolic rate,L1-L4 BMD and femoral neck BMD in the bone mass loss group were lower than those in the normal bone mass group(P <0.05).3.Compared with the normal bone mass group,the bone mass loss group had lower L3-SMI and higher proportion of sarcopenia(P<0.05).4.According to the results of multivariate Logistic regression analysis,sarcopenia[odds ratio(OR)=8.737,95% confidence interval(95%CI):2.237～34.129],age(OR=1.094,95%CI:1.019～1.175)and N-MID(OR=1.095,95%CI:1.019～1.176)were independent risk factors for bone mass loss in patients with cirrhosis(P <0.05).5.According to ROC curve,the area under the curve(AUC)of L3-SMI,age and N-MID for predicting bone mass loss were 0.766,0.705 and 0.691.There was no significant difference in the predictive ability of the three indexes(P>0.05).6.Correlation analysis showed that total muscle mass,muscle mass of trunk and limbs,bone mass,basal metabolism rate and body water mass in body component analysis were positively correlated with L1-L4 BMD and femoral neck BMD(P<0.05),and fat mass was positively correlated with L1-L4 BMD(P<0.05).Conclusion(s):1.Elderly patients,female patients,increased N-MID level,increased β-CTX level,decreased CT level,decreased total muscle mass and limb muscle mass,decreased bone mass,low basal metabolic rate and decreased body water mass are the characteristics of bone mass loss in patients with cirrhosis.2.Sarcopenia in patients with cirrhosis may promote bone mass loss.3.Older age,high N-MID level and sarcopenia are independent risk factors for bone mass loss in patients with liver cirrhosis.4.Age,N-MID and L3-SMI are effective indicators for predicting bone mass loss.5.The muscle mass,bone mass,fat mass,basal metabolism rate and body water mass in body composition analysis are positively correlated with bone mineral density.It is suggested that detailed assessment of body composition changes by bioelectrical impedance analysis is helpful to detect bone mineral density abnormalities in patients with cirrhosis.At the same time,optimizing body composition can help protect bone health. |
