Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4038-4047
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4038
Osteoporosis and bone fractures in alcoholic liver disease: A meta-analysis
Chang Seok Bang, In Soo Shin, Sung Wha Lee, Jin Bong Kim, Gwang Ho Baik, Ki Tae Suk, Jai Hoon Yoon, Yeon Soo Kim, Dong Joon Kim
Chang Seok Bang, Sung Wha Lee, Jin Bong Kim, Gwang Ho Baik, Ki Tae Suk, Jai Hoon Yoon, Yeon Soo Kim, Dong Joon Kim, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea
In Soo Shin, College of Education, Jeonju University, Jeonju 560-759, South Korea
Author contributions: Kim DJ and Bang CS designed research; Bang CS, Lee SW, Suk KT, Yoon JH and Kim YS performed research; Shin IS, Kim JB, Baik GH and Kim DJ contributed new reagent/analytic tools; Bang CS and Kim DJ analyzed data; Bang CS wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Joon Kim, MD, PhD, Department of Internal Medicine, Hallym University College of Medicine, Kyo-dong, Chuncheon 200-704, South Korea. djkim@hallym.ac.kr
Telephone: +82-33-240-5647 Fax: +82-33-241-8064
Received: September 14, 2014
Peer-review started: September 15, 2014
First decision: October 14, 2014
Revised: October 17, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
Processing time: 205 Days and 1.3 Hours
Abstract

AIM: To evaluate the association between alcoholic liver disease (ALD) and bone fractures or osteoporosis.

METHODS: Non-randomized studies were identified from databases (PubMed, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included “alcoholic liver diseases”, “osteoporosis”, or “bone fractures”. The prevalence of any fractures or osteoporosis, and bone mineral density (BMD) were extracted and analyzed using risk ratios and standardized mean difference (SMD). A random effects model was applied.

RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944 (95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849 (95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD (SMD in femur-BMD: -0.172, 95%CI: -0.453-0.110; SMD in spine-BMD: -0.169, 95%CI: -0.476-0.138). Sensitivity analyses showed consistent results.

CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.

Keywords: Alcoholic liver diseases; Bone fractures; Osteoporosis

Core tip: Excessive alcohol consumption is a well-established risk factor for osteoporosis and bone fractures. However, light amounts of alcohol ingestion is known to be associated with higher bone mineral density (BMD) and low fracture rates. This study evaluated the current evidence regarding osteoporosis and bone fractures in alcoholic liver disease (ALD). In this meta-analysis, there was significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis. Although the mechanism of bone fractures in ALD is not totally understood, further research utilizing a homogenous population and controlling for confounding risk factors for fractures could elucidate the mechanism.