Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2023; 29(29): 4580-4592
Published online Aug 7, 2023. doi: 10.3748/wjg.v29.i29.4580
Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis
Jia-Liang Chen, Yao Liu, Yu-Fei Bi, Xian-Bo Wang
Jia-Liang Chen, Yao Liu, Yu-Fei Bi, Xian-Bo Wang, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Author contributions: Chen JL and Wang XB designed the research; Chen JL, Liu Y and Bi YF performed the research; Chen JL and Liu Y analyzed the data; Chen JL wrote the manuscript; Wang XB supervised the report; all authors reviewed and approved the final manuscript.
Supported by Capital’s Funds for Health Improvement and Research, No. CFH2018-1-2172; and Beijing Ditan Hospital Scientific Research Fund Project, No. DTYM202102.
Institutional review board statement: The study was approved by the Institutional Ethical Review Board of Beijing Ditan Hospital, No. DTEC-KT2022-010-01.
Informed consent statement: As this study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xian-Bo Wang, MD, PhD, Chief Physician, Professor, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing 100015, China. wangxb@ccmu.edu.cn
Received: June 7, 2023
Peer-review started: June 7, 2023
First decision: June 16, 2023
Revised: June 21, 2023
Accepted: July 19, 2023
Article in press: July 19, 2023
Published online: August 7, 2023
Processing time: 56 Days and 0.2 Hours
Abstract
BACKGROUND

Osteoporosis is an extrahepatic complication of primary biliary cholangitis (PBC) that increases the risk of fractures and mortality. However, Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack.

AIM

To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC.

METHODS

This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021. We defined subjects with T-scores ≤ -2.5 in any sites (L1 to L4, femoral neck, or total hip) as having osteoporosis. Demographic, serological, clinical, and histological data were collected. Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis.

RESULTS

A total of 268 patients with PBC [236 women (88.1%); mean age, 56.7 ± 10.6 years; 163 liver biopsies (60.8%)] were included. The overall prevalence of osteoporosis in patients with PBC was 45.5% (122/268), with the prevalence of osteoporosis in women and men being 47.0% and 34.4%, respectively. The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women (56.3% vs 21.0%, P < 0.001). Osteoporosis in patients with PBC is associated with age, fatigue, menopausal status, previous steroid therapy, body mass index (BMI), splenomegaly, gastroesophageal varices, ascites, Mayo risk score, histological stage, alanine aminotransferase, albumin, bilirubin, platelet and prothrombin activity. Multivariate regression analysis identified that older age, lower BMI, previous steroid therapy, higher Mayo risk score, and advanced histological stage as the main independent risk factors for osteoporosis in PBC.

CONCLUSION

Osteoporosis is very common in Chinese patients with PBC, allowing for prior screening of BMD in those PBC patients with older age, lower BMI, previous steroid therapy and advanced liver disease.

Keywords: Primary biliary cholangitis; Osteoporosis; Bone mineral density; Dual-energy X-ray absorptiometry; Prevalence; Chinese

Core Tip: In this paper, we reported for the first large-sample study to explore the prevalence and potential risk factors for osteoporosis in Chinese patients with primary biliary cholangitis (PBC). The prevalence of osteoporosis in Chinese patients with PBC was 45.5%. Osteoporosis in PBC is strongly associated with older age, lower body mass index, previous steroid use, the severity of liver disease, and advanced histological stage. This study provides reference information for future PBC-related guideline development and public policy formulation in China and the Asia-Pacific region.