Bone disease in primary biliary cirrhosis: independent indicators and rateof progression

Background/Aims: To identify indicators of osteoporosis and to determine th e rate of bone loss in patients with primary biliary cirrhosis (PBC). Methods: Bone mineral density of the lumbar spine and hip was measured at a nnual intervals over 7 years of followup in 176 patients with PBC. Results: Osteoporosis (t-score below -2.5) was found in 20 % of patients an d occurred 32.1 times more frequently in patients with PBC than expected. P atients with histologic stage 3 or 4 disease had a 5.4-fold increased risk of osteoporosis compared to patients with stage 1 or 2. Age, body mass inde x, advanced stage (3 or 4), and history of fractures were the only independ ent indicators of osteoporosis. After 3 years of follow up, the rate of bon e loss in patients with stage 1 or 2 increased and equaled that seen in pat ients with stage 3 or 4. Serum bilirubin level was the only variable indepe ndently associated with the rate of bone loss over time. Conclusions: Severity of the liver disease contributes significantly to the severity of bone disease in PBC. PBC patients who are older, thinner and h ave more advanced liver disease may have the most benefit from bone density measurements and treatment for their osteoporosis. (C) 2001 European Assoc iation for the Study of the Liver. Published by Elsevier Science B.V. All r ights reserved.