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Liu Y, Yuan M, He J, Cai L, Leng A. The Impact of Non-alcohol Fatty Liver Disease on Bone Mineral Density is Mediated by Sclerostin by Mendelian Randomization Study. Calcif Tissue Int 2024; 114:502-512. [PMID: 38555554 DOI: 10.1007/s00223-024-01204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/19/2024] [Indexed: 04/02/2024]
Abstract
Non-alcoholic fatty liver disease (NAFLD) has been found to be associated with osteoporosis (OP) in observational studies. However, the precise causal relationship between NAFLD and OP remains unclear. Here, we used Mendelian randomization (MR) to explore the causal relationship. We selected NAFLD-related single-nucleotide polymorphisms from a genome-wide meta-analysis (8434 cases and 434,770 controls) as instrumental variants. We used inverse variance weighted analysis for the primary MR analysis. Furthermore, we used similar methodologies in parallel investigations of other chronic liver diseases (CLDs). We performed sensitivity analyses to ensure the reliability of the results. We observed a causality between NAFLD and forearm bone mineral density (FABMD) (beta-estimate [β]: - 0.212; p-value: 0.034). We also found that sclerostin can act as a mediator to influence the NAFLD and FABMD pathways to form a mediated MR network (mediated proportion = 8.8%). We also identified indications of causal relationships between other CLDs and OP. However, we were unable to establish any associated mediators. Notably, our analyses did not yield any evidence of pleiotropy. Our findings have implications in the development of preventive and interventional measures aimed at managing low bone mineral density in patients with NAFLD.
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Affiliation(s)
- Yuan Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, No.88 Xiangya Road, Kaifu District, Changsha, 410000, Hunan Province, China
| | - Mengqin Yuan
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian He
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Longjiao Cai
- Department of Gastroenterology, Xiangya Hospital, Central South University, No.88 Xiangya Road, Kaifu District, Changsha, 410000, Hunan Province, China
| | - Aimin Leng
- Department of Gastroenterology, Xiangya Hospital, Central South University, No.88 Xiangya Road, Kaifu District, Changsha, 410000, Hunan Province, China.
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2
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Jadzic J, Milovanovic P, Tomanovic N, Zivkovic V, Djukic D, Nikolic S, Djuric M, Djonic D. Micro-scale vertebral features in postmenopausal women with alcohol-associated and metabolic-associated fatty liver disease: ex vivo bone quality analyses. J Endocrinol Invest 2024; 47:131-140. [PMID: 37296370 DOI: 10.1007/s40618-023-02130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Although epidemiological studies indicate increased fracture risk in women with alcohol-associated liver disease (AALD) and metabolic-associated fatty liver disease (MAFLD), data about their micro-scale bone features are still limited. We aimed to characterize bone quality changes in the anterior mid-transverse part of the first lumbar vertebral body collected from 32 adult postmenopausal females. Based on pathohistological assessment of the liver tissue, individuals were divided into AALD (n = 13), MAFLD (n = 9), and control group (n = 10). METHODS We analyzed trabecular and cortical micro-architecture (using micro-computed tomography), bone mechanical properties (using Vickers microhardness tester), osteocyte lacunar network and bone marrow adiposity morphology (using optic microscopy). Data were adjusted to elude the covariant effects of advanced age and body mass index on our results. RESULTS Our data indicated a minor trend toward deteriorated bone quality in MAFLD women, presented in impaired trabecular and cortical micro-architectural integrity, which could be associated with bone marrow adiposity alterations noted in these women. Additionally, we observed a significant decline in micro-architectural, mechanical, and osteocyte lacunar features in lumbar vertebrae collected from the AALD group. Lastly, our data indicated that vertebral bone deterioration was more prominent in the AALD group than in the MAFLD group. CONCLUSION Our data suggested that MAFLD and AALD are factors that could play a part in compromised vertebral strength of postmenopausal women. Also, our data contribute to understanding the multifactorial nature of bone fragility in these patients and highlight the necessity for developing more effective patient-specific diagnostic, preventive, and therapeutic strategies.
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Affiliation(s)
- J Jadzic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - P Milovanovic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - N Tomanovic
- Faculty of Medicine, Institute of Pathology, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
| | - V Zivkovic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - D Djukic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - S Nikolic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - M Djuric
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - D Djonic
- Faculty of Medicine, Center of Bone Biology, University of Belgrade, Dr. Subotica 4/2, 11000, Belgrade, Serbia.
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3
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Craven BC, Cirnigliaro CM, Carbone LD, Tsang P, Morse LR. The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury. J Pers Med 2023; 13:966. [PMID: 37373955 DOI: 10.3390/jpm13060966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). METHODS Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. RESULTS This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. CONCLUSIONS Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.
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Affiliation(s)
- Beverley Catharine Craven
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation, Research, and Development Service, Spinal Cord Damage Research Center, Bronx, NY 10468, USA
| | - Laura D Carbone
- Department of Medicine: Rheumatology, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Philemon Tsang
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, 500 Harvard St SE, Minneapolis, MN 55455, USA
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4
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Jadzic J, Djonic D. Bone loss in chronic liver diseases: Could healthy liver be a requirement for good bone health? World J Gastroenterol 2023; 29:825-833. [PMID: 36816627 PMCID: PMC9932432 DOI: 10.3748/wjg.v29.i5.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 01/12/2023] [Indexed: 02/06/2023] Open
Abstract
Given that the liver is involved in many metabolic mechanisms, it is not surprising that chronic liver disease (CLD) could have numerous complications. Secondary osteoporosis and increased bone fragility are frequently overlooked complications in CLD patients. Previous studies implied that up to one-third of these individuals meet diagnostic criteria for osteopenia or osteoporosis. Recent publications indicated that CLD-induced bone fragility depends on the etiology, duration, and stage of liver disease. Therefore, the increased fracture risk in CLD patients puts a severe socioeconomic burden on the health system and urgently requires more effective prevention, diagnosis, and treatment measures. The pathogenesis of CLD-induced bone loss is multifactorial and still insufficiently understood, especially considering the relative impact of increased bone resorption and reduced bone formation in these individuals. It is essential to note that inconsistent findings regarding bone mineral density measurement were previously reported in these individuals. Bone mineral density is widely used as the “golden standard” in the clinical assessment of bone fragility although it is not adequate to predict individual fracture risk. Therefore, microscale bone alterations (bone microstructure, mechanical properties, and cellular indices) were analyzed in CLD individuals. These studies further support the thesis that bone strength could be compromised in CLD individuals, implying that an individualized approach to fracture risk assessment and subsequent therapy is necessary for CLD patients. However, more well-designed studies are required to solve the bone fragility puzzle in CLD patients.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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5
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Wester A, Ndegwa N, Hagström H. Risk of Fractures and Subsequent Mortality in Alcohol-Related Cirrhosis: A Nationwide Population-Based Cohort Study. Clin Gastroenterol Hepatol 2022; 21:1271-1280.e7. [PMID: 35811047 DOI: 10.1016/j.cgh.2022.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Alcohol-related cirrhosis is linked to increased risk of fractures, but this has seldom been quantified nationally or compared against control subjects without cirrhosis. Here, we determined the rate and risk of fractures and postfracture mortality in patients with alcohol-related cirrhosis compared with individuals from the general population. METHODS In this nationwide population-based cohort study, data were retrieved from the Swedish National Patient Registry on 25,090 patients with alcohol-related cirrhosis from 1969-2016. Patients were matched for sex, age, and municipality with 239,458 control subjects from the Swedish Total Population Registry. Cox regression models were fitted to investigate the rates of fractures and postfracture mortality. The cumulative incidence of fractures was calculated while accounting for competing risks (death or liver transplantation). RESULTS A total of 48,635 fractures occurred during 3,468,860 person-years of follow-up. Patients with alcohol-related cirrhosis had a higher fracture rate per 1000 person-years (38.7) than control subjects (13.3; adjusted hazard ratio, 3.8; 95% confidence interval, 3.6-3.9). The cumulative incidence of fractures was elevated for patients the first 19 years of follow-up, with a 5-year risk of 9.6% compared with 4.5% for control subjects. Patients with alcohol-related cirrhosis had a higher postfracture mortality rate compared with control subjects who also experienced a fracture, at both 30 days (adjusted hazard ratio, 1.6; 95% confidence interval, 1.4-1.8) and 1 year (adjusted hazard ratio, 1.8; 95% confidence interval, 1.7-2.0). CONCLUSIONS Alcohol-related cirrhosis is associated with an almost 4-fold increased fracture rate, a higher risk of fractures the first 2 decades after initial diagnosis, and higher postfracture mortality. Preventive interventions to reduce modifiable fracture risk factors in this population are justified.
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Affiliation(s)
- Axel Wester
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Nelson Ndegwa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Esophageal and Gastric Cancer Unit, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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6
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Zhang X, Ding K, Miao X, Wang J, Hu B, Shen J, Hu X, Xu Y, Yu B, Tu T, Lin A, Chen X, Huang Y. Associations between bone mineral density and chronic obstructive pulmonary disease. J Int Med Res 2022; 50:3000605221094644. [PMID: 35579181 PMCID: PMC9127852 DOI: 10.1177/03000605221094644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the relationship between chronic obstructive pulmonary disease (COPD) severity and bone mineral density (BMD) in the whole body and different body areas. Methods This retrospective, cross-sectional study included patients with COPD. Demographic and lung function data, COPD severity scales, BMD, and T scores were collected. Patients were grouped by high (≥–1) and low (<–1) T scores, and stratified by body mass index, airway obstruction, dyspnoea, and exercise capacity (BODE) index. The relationship between whole-body BMD and BODE was evaluated by Kendall’s tau-b correlation coefficient. Risk factors associated with COPD severity were identified by univariate analyses. BMD as an independent predictor of severe COPD (BODE ≥5) was verified by multivariate logistic regression. BMD values in different body areas for predicting severe COPD were assessed by receiver operating characteristic curves. Results Of 88 patients with COPD, lung-function indicators and COPD severity were significantly different between those with high and low T scores. Whole-body BMD was inversely related to COPD severity scales, including BODE. Multivariate logistic regression revealed that BMD was independently associated with COPD severity. The area under the curve for pelvic BMD in predicting severe COPD was 0.728. Conclusion BMD may be a novel marker in predicting COPD severity, and pelvic BMD may have the strongest relative predictive power.
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Affiliation(s)
- Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Binbin Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jiamin Shen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xueting Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yage Xu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Yu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tingting Tu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Aiju Lin
- Department of Endocrinology, Bone Density Research Laboratory, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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7
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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8
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Jadzic J, Milovanovic P, Cvetkovic D, Ivovic M, Tomanovic N, Bracanovic M, Zivkovic V, Nikolic S, Djuric M, Djonic D. Mechano-structural alteration in proximal femora of individuals with alcoholic liver disease: Implications for increased bone fragility. Bone 2021; 150:116020. [PMID: 34044170 DOI: 10.1016/j.bone.2021.116020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
Although increased hip fracture risk is noted in patients with alcoholic liver disease (ALD), their femoral microstructural and mechanical properties were not investigated previously. The present study aimed to analyze the associations between subregional deteriorations in femoral mechano-structural properties and clinical imaging findings to explain increased femoral fracture risk among ALD patients. This study analyzed proximal femora of 33 male cadaveric donors, divided into ALD (n = 13, 57 ± 13 years) and age-matched control group (n = 20, 54 ± 13 years). After pathohistological verification of ALD stage, DXA and HSA measurements of the proximal femora were performed, followed by micro-CT and Vickers microindentation of the superolateral neck, inferomedial neck, and intertrochanteric region. Bone mineral density and cross sectional area of the femoral neck were deteriorated in ALD donors, compared with healthy controls (p < 0.05). Significant ALD-induced degradation of trabecular and cortical microstructure and Vickers microhardness reduction were noted in the analyzed femoral regions (p < 0.05). Still, the most prominent ALD-induced mechano-structural deterioration was noted in intertrochanteric region. Additionally, more severe bone alterations were observed in individuals with an irreversible stage of ALD, alcoholic liver cirrhosis (ALC), than in those with an initial ALD stage, fatty liver disease. Observed osteodensitometric and mechano-structural changes illuminate the basis for increased femoral fracture risk in ALD patients. Additionally, our data suggest bone strength reduction that may result in increased susceptibility to intertrochanteric femoral fracture in men with ALD. Thus, femoral fracture risk assessment should be advised for all ALD patients, especially in those with ALC.
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Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Danica Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Miomira Ivovic
- Institute for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr. Subotica no. 13, Belgrade, Serbia
| | - Nada Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 1, Belgrade, Serbia
| | - Milos Bracanovic
- Clinic for Emergency Surgery, Clinical Center of Serbia, Pasterova no. 2, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Deligradska no. 31a, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia.
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9
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Jadzic J, Cvetkovic D, Tomanovic N, Zivkovic V, Nikolic S, Milovanovic P, Djuric M, Djonic D. The severity of hepatic disorder is related to vertebral microstructure deterioration in cadaveric donors with liver cirrhosis. Microsc Res Tech 2020; 84:840-849. [PMID: 33170963 DOI: 10.1002/jemt.23642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/26/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
Patients with liver cirrhosis (LC) commonly suffer from osteoporosis and vertebral fracture, but data about their vertebral micro-architectural changes are still limited. This study aimed to evaluate the potential differences in trabecular micro-architecture of lumbar vertebrae between male LC patients and healthy controls, in relation to etiology and pathohistological scoring of the liver disorder. After pathohistological examination of liver tissue, micro-computed tomography was performed on the vertebral samples included into: alcoholic liver cirrhosis group (ALC; n = 16; age: 59 ± 8 years), non-alcoholic liver cirrhosis group (non-ALC; n = 15; age: 69 ± 10 years) and control group (n = 16; age: 58 ± 6 years). Our data showed significant impairment of the trabecular microstructure in the lumbar vertebrae from LC donors, regardless of the alcoholic/non-alcoholic origin of liver disorder, as illustrated by lower BV/TV, Tb.Th, and Tb.N compared with controls (p < .05). Moreover, depredation in trabecular micro-architecture was inversely associated with pathohistological scores (p < .05), indicating that severity of liver disorder could be an important predictor of reduced vertebral strength in LC. We noticed significant micro-architectural deterioration in the trabecular compartment of the lumbar vertebrae of male individuals with alcoholic and non-alcoholic LC, which was associated with the severity of the liver disease. Thus, clinical assessment of fracture risk should be advised for all LC patients, regardless of the alcoholic origin of liver cirrhosis. Additionally, adequate and timely treatment of liver disorder may decelerate the progression of bone impairment in LC patients.
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Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danica Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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10
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Jadzic J, Cvetkovic D, Milovanovic P, Tomanovic N, Zivkovic V, Nikolic S, Djuric M, Djonic D. The micro-structural analysis of lumbar vertebrae in alcoholic liver cirrhosis. Osteoporos Int 2020; 31:2209-2217. [PMID: 32577771 DOI: 10.1007/s00198-020-05509-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Although vertebral fracture is more common among alcoholic liver cirrhosis patients when compared to general population, current data on three-dimensional micro-architecture are scarce. Our study showed significant trabecular deterioration in lumbar vertebrae obtained from alcoholic liver cirrhosis donors, suggesting that they should be advised to undergo early-stage screening for osteoporosis. PURPOSE Recent studies showed an increased incidence of vertebral fractures in alcoholic liver cirrhosis (ALC) patients, while data about vertebral micro-structure are still limited. The aim of this study was to compare trabecular and cortical micro-architecture of lumbar vertebrae between ALC patients and healthy age- and sex-matched controls. METHODS Our study included lumbar vertebral samples of male cadaveric donors, divided into ALC (n = 20, age: 59 ± 6 years) and control group (n = 20, age: 59 ± 8 years). Following pathohistological verification of liver cirrhosis, trabecular and cortical bone micro-architecture was analyzed by micro-computed tomography (micro-CT). RESULTS Micro-CT evaluation of the trabecular bone in lumbar vertebrae showed a significant decrease in bone volume fraction, trabecular thickness, trabecular number, and connectivity (p < 0.01). In contrast to trabecular deterioration, prominent alteration in cortical parameters was not observed in lumbar vertebrae of ALC patients (p > 0.05). CONCLUSIONS Our data indicate that susceptibility to non-traumatic fractures in ALC patients could be explained by alterations in trabecular bone micro-architecture. Thus, we genuinely recommend osteological screening of the lumbar spine for all ALC patients in order to evaluate individual fracture risk. Graphical abstract.
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Affiliation(s)
- J Jadzic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - P Milovanovic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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11
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Lu M, Liu Y, Shao M, Tesfaye GC, Yang S. Associations of Iron Intake, Serum Iron and Serum Ferritin with Bone Mineral Density in Women: The National Health and Nutrition Examination Survey, 2005-2010. Calcif Tissue Int 2020; 106:232-238. [PMID: 31754762 DOI: 10.1007/s00223-019-00627-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
The relationship between iron and bone mineral density (BMD) is still poorly understood. We investigated the associations of iron intake, serum iron and serum ferritin with BMD. This cross-sectional study identified 4000 females aged 12 to 49 years with complete and valid data on iron intake, serum iron, serum ferritin, and femoral neck and lumbar spine BMD from the National Health and Nutrition Examination Survey 2005-2010. Daily iron intake was the mean intake of iron nutrient ascertained from two consecutive 24-h dietary recalls; serum iron and serum ferritin were directly measured with established methods. Femoral neck and lumbar spine BMD were measured by Dual-energy X-ray absorptiometry (DXA). After adjusting for multiple covariates (i.e., age, body mass index and race), we used linear regression and generalized additive models (GAMs) to test the linear and non-linear associations of iron intake, serum iron and serum ferritin with BMD. The mean age of this study was 27.70 years (SD = 11.88 years). Higher serum ferritin was associated with lower femoral neck and lumbar spine BMD (all adjusted P < 0.05); iron intake and serum iron were not associated with femoral neck and lumbar spine BMD. Similar results were found when iron levels were classified as iron deficiency, normal iron and iron overload. There were no obvious non-linear relationships between the above three iron variables and BMD in the GAM analyses. There was a negative and linear association between serum ferritin and BMD; iron intake and serum iron were not associated with BMD. Serum ferritin appeared to be a better iron variable than iron intake and serum iron in relation to BMD.
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Affiliation(s)
- Meihan Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Mengyun Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Getachew C Tesfaye
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China.
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12
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Jadžić J, Đonić D. Compromised bone strength in patients with alcoholic liver cirrhosis. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-27443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Osteoporosis and/or osteopenia are frequently observed complications in alcoholic liver disease patients, especially in its irreversible stage (alcoholic liver cirrhosis - ALC). Current literature review regarding osteoporosis incidence increased fracture risk, bone mineral density changes, micro-structural alteration and pathogenetic mechanisms leading to ALC - induced decrease in bone quality is presented. It has been reported that osteoporosis is influenceing significant number of ALC patients, with particular accent on lumbar spine, as most commonly affected skeletal site. Several risk factors and ethio-pathogenic mechanisms have been associated with the loss of bone mineral density, in patients with ALC and other cirrhosis. Certain authors claim that dominant mechanism in ALC-induced bone loss is decrease in bone formation and osteoblastic function, while other results suggest increased bone remodeling as underlying cause of increased bone fragility in ALC patients. Increased bone fragility and susceptibility to osteoporotic fractures significantly affect life expectancy and quality of life in patients with ALC. Thus, osteological screening and individual fracture risk assessment are highly recommended for all patients with alcoholic liver cirrhosis.
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13
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Kovalic AJ, Cholankeril G, Satapathy SK. Nonalcoholic fatty liver disease and alcoholic liver disease: metabolic diseases with systemic manifestations. Transl Gastroenterol Hepatol 2019; 4:65. [PMID: 31620647 DOI: 10.21037/tgh.2019.08.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
The progression of liver disease is portrayed by several common, overarching signs and symptoms. Classically, these include findings such as spider angiomata, jaundice, palmar erythema, and as cirrhosis decompensates, ascites, variceal hemorrhage (VH), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC). Aside from these universal hallmarks among cirrhotics, patients with nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) harbor their own distinct systemic associations and manifestations. NAFLD is tightly linked to metabolic syndrome, which appears to be a driving force for a multitude of comorbidities, such as insulin resistance, cardiovascular disease, chronic kidney disease (CKD), obstructive sleep apnea (OSA), as well as increased malignancy risk. ALD also maintains a variety of comorbidities congruent with systemic effects of chronic alcohol use. These findings are highlighted by cardiovascular conditions, neuronal damage, myopathy, nutritional deficiencies, chronic pancreatitis, in addition to increased malignancy risk. While a general, guideline-driven management for all cirrhotic patients remains imperative for minimizing risk of complications, a tailored treatment strategy is useful for patients with NAFLD and ALD who entertain their own constellation of unique systemic manifestations.
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Affiliation(s)
- Alexander J Kovalic
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases & Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
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14
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Fernandes B, Dias E, Mascarenhas-Saraiva M, Bernardes M, Costa L, Cardoso H, Macedo G. Rheumatologic manifestations of hepatic diseases. Ann Gastroenterol 2019; 32:352-360. [PMID: 31263357 PMCID: PMC6595923 DOI: 10.20524/aog.2019.0386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
The course of hepatic diseases may be complicated by a multitude of rheumatologic manifestations, which can complicate the diagnostic approach and alter the natural history of primary liver disease, sometimes worsening prognosis due to associated multiple organ dysfunction. These manifestations can occur in association with a multitude of liver diseases, including viral hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis, or Wilson’s disease. It is necessary not only for rheumatologists, but also for other clinicians, to be aware that these atypical manifestations may reflect an undiagnosed hepatic disease. On the other hand, it is crucial that, in a patient with known hepatic disease presenting with rheumatologic symptoms, an accurate distinction be made between the rheumatologic manifestations of hepatic disease and primary rheumatologic disease, since the treatment is often different. This review aims to summarize the current evidence regarding rheumatologic manifestations of hepatic diseases, how to distinguish them from primary rheumatologic disorders, and how to provide adequate management.
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Affiliation(s)
- Bruno Fernandes
- Rheumatology Department (Bruno Fernandes, Miguel Bernardes, Lúcia Costa)
| | - Emanuel Dias
- Gastrenterology Department (Emanuel Dias, Miguel Mascarenhas-Saraiva, Hélder Cardoso, Guilherme Macedo), Centro Hospitalar de São João, Porto, Portugal
| | - Miguel Mascarenhas-Saraiva
- Gastrenterology Department (Emanuel Dias, Miguel Mascarenhas-Saraiva, Hélder Cardoso, Guilherme Macedo), Centro Hospitalar de São João, Porto, Portugal
| | - Miguel Bernardes
- Rheumatology Department (Bruno Fernandes, Miguel Bernardes, Lúcia Costa)
| | - Lúcia Costa
- Rheumatology Department (Bruno Fernandes, Miguel Bernardes, Lúcia Costa)
| | - Hélder Cardoso
- Gastrenterology Department (Emanuel Dias, Miguel Mascarenhas-Saraiva, Hélder Cardoso, Guilherme Macedo), Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastrenterology Department (Emanuel Dias, Miguel Mascarenhas-Saraiva, Hélder Cardoso, Guilherme Macedo), Centro Hospitalar de São João, Porto, Portugal
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15
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Otete H, Deleuran T, Fleming KM, Card T, Aithal GP, Jepsen P, West J. Hip fracture risk in patients with alcoholic cirrhosis: A population-based study using English and Danish data. J Hepatol 2018; 69:697-704. [PMID: 29673756 DOI: 10.1016/j.jhep.2018.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Cirrhosis, the prevalence of which is increasing, is a risk factor for osteoporosis and fractures. However, little is known of the actual risk of hip fractures in patients with alcoholic cirrhosis. Using linked primary and secondary care data from the English and Danish nationwide registries, we quantified the hip fracture risk in two national cohorts of patients with alcoholic cirrhosis. METHODS We followed 3,706 English and 17,779 Danish patients with a diagnosis of alcoholic cirrhosis, and we identified matched controls from the general populations. We estimated hazard ratios (HR) of hip fracture for patients vs. controls, adjusted for age, sex and comorbidity. RESULTS The five-year hip fracture risk was raised both in England (2.9% vs. 0.8% for controls) and Denmark (4.6% vs. 0.9% for controls). With confounder adjustment, patients with cirrhosis had fivefold (adjusted HR 5.5; 95% CI 4.3-6.9), and 8.5-fold (adjusted HR 8.5; 95% CI 7.8-9.3) increased rates of hip fracture, in England and Denmark, respectively. This association between alcoholic cirrhosis and risk of hip fracture showed significant interaction with age (p <0.001), being stronger in younger age groups (under 45 years, HR 17.9 and 16.6 for English and Danish patients, respectively) than in patients over 75 years (HR 2.1 and 2.9, respectively). In patients with alcoholic cirrhosis, 30-day mortality following a hip fracture was 11.1% in England and 10.0% in Denmark, giving age-adjusted post-fracture mortality rate ratios of 2.8(95% CI 1.9-3.9) and 2.0(95% CI 1.5-2.7), respectively. CONCLUSIONS Patients with alcoholic cirrhosis have a markedly increased risk of hip fracture and post-hip fracture mortality compared with the general population. These findings support the need for more effort towards fracture prevention in this population, to benefit individuals and reduce the societal burden. LAY SUMMARY Alcoholic cirrhosis creates a large public health burden and is a risk factor for bone fractures. Based on data from England and Denmark, we found that hip fractures occur more than five times more frequently in people with alcoholic cirrhosis than in people without the disease. Additionally, the aftermath of the hip fracture is severe, such that up to 11% of patients with alcoholic cirrhosis die within 30 days after their hip fracture. These results suggest that efforts directed towards fracture prevention in people with alcoholic cirrhosis could be beneficial.
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Affiliation(s)
- Harmony Otete
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, United Kingdom; School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, United Kingdom; School of Medicine, University of Central Lancashire, Harrington building 242, Preston PR1 2HE, United Kingdom.
| | - Thomas Deleuran
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg Denmark
| | - Kate M Fleming
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, United Kingdom
| | - Tim Card
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Guru P Aithal
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Joe West
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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16
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Jeynes KD, Gibson EL. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend 2017; 179:229-239. [PMID: 28806640 DOI: 10.1016/j.drugalcdep.2017.07.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nutrition is a prerequisite for health; yet, there is no special nutritional assessment or guidance for drug and alcohol dependent individuals, despite the fact that their food consumption is often very limited, risking malnutrition. Further, the premise is examined that malnutrition may promote drug seeking and impede recovery from substance use disorders (SUD). METHOD A narrative review addressed the relationship between substance use disorders and nutrition, including evidence for malnutrition, as well as their impact on metabolism and appetite regulation. The implications of the biopsychology of addiction and appetite for understanding the role of nutrition in SUD were also considered. RESULTS The literature overwhelmingly finds that subjects with alcohol use disorder (AUD) and drug use disorder (DUD) typically suffer from nutrient deficiencies. These nutrient deficiencies may be complicit in the alcoholic myopathy, osteopenia and osteoporosis, and mood disorders including anxiety and depression, observed in AUD and DUD. These same individuals have also been found to have altered body composition and altered hormonal metabolic regulators. Additionally, brain processes fundamental for survival are stimulated both by food, particularly sweet foods, and by substances of abuse, with evidence supporting confusion (addiction transfer) when recovering from SUD between cravings for a substance and craving for food. CONCLUSION Poor nutritional status in AUD and DUD severely impacts their physical and psychological health, which may impede their ability to resist substances of abuse and recover their health. This review contributes to a better understanding of interventions that could best support individuals with substance use disorders.
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Affiliation(s)
- Kendall D Jeynes
- Department of Life Sciences, Whitelands College, University of Roehampton, London SW15 4JD, UK
| | - E Leigh Gibson
- Department of Psychology, Whitelands College, University of Roehampton, Holybourne Avenue, London SW15 4JD, UK.
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17
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Bone health and vitamin D status in alcoholic liver disease. Indian J Gastroenterol 2016; 35:253-9. [PMID: 27246833 DOI: 10.1007/s12664-016-0652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/26/2016] [Indexed: 02/07/2023]
Abstract
Alcohol consumption is harmful to many organs and tissues, including bones, and it leads to osteoporosis. Hepatic osteodystrophy is abnormal bone metabolism that has been defined in patients with chronic liver disease (CLD), including osteopenia, osteoporosis, and osteomalacia. Decreased bone density in patients with CLD results from decreased bone formation or increased bone resorption. The prevalence of osteopenia in alcoholic liver disease (ALD) patients is between 34 % and 48 %, and the prevalence of osteoporosis is between 11 % and 36 %. Cirrhosis is also a risk factor for osteoporosis. The liver has an important role in vitamin D metabolism. Ninety percent of patients with alcoholic liver cirrhosis have vitamin D inadequacy (<80 nmol/L). The lowest serum vitamin D levels were observed in patients with Child-Pugh class C. Bone densitometry is used for the definitive diagnosis of osteoporosis in ALD. There are no specific controlled clinical studies on the treatment of osteoporosis in patients with ALD. Alcohol cessation and abstinence are principal for the prevention and treatment of osteoporosis in ALD patients, and the progression of osteopenia can be stopped in this way. Calcium and vitamin D supplementation is recommended, and associated nutritional deficiencies should also be corrected. The treatment recommendations of osteoporosis in CLD tend to be extended to ALD. Bisphosphonates have been proven to be effective in increasing bone mineral density (BMD) in chronic cholestatic disease and post-transplant patients, and they can be used in ALD patients. Randomized studies assessing the management of CLD-associated osteoporosis and the development of new drugs for osteoporosis may change the future. Here, we will discuss bone quality, vitamin D status, mechanism of bone effects, and diagnosis and treatment of osteoporosis in ALD.
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18
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Guarino M, Loperto I, Camera S, Cossiga V, Di Somma C, Colao A, Caporaso N, Morisco F. Osteoporosis across chronic liver disease. Osteoporos Int 2016; 27:1967-77. [PMID: 26846777 DOI: 10.1007/s00198-016-3512-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023]
Abstract
Osteoporosis is a complication of chronic liver disease, with impact on morbidity, quality of life, and survival. The progress of medicine and the new therapies stretched the disease's natural history and improved the survival of patients with liver disease. So, it is fundamental to make better the quality of life and to prevent complications. Metabolic bone disorders are common complications of chronic liver disease (CLD). Patients with CLD have an increased risk of bone fractures, with significant impact on morbidity, quality of life, and even on survival. Bone diseases, including osteomalacia, osteoporosis, and osteopenia, are frequently observed in many types of liver disease. The pathogenesis of damage and the mechanisms of bone loss are different in relation to the specific liver disease. The relevance of these conditions induced many authors to create a new nosographic entity known as "hepatic osteodystrophy", although this term is rarely used anymore and it is now commonly referred to as osteopenia or osteoporosis associated with chronic liver disease. This review is based on the personal experiences of the authors and upon research done of the available literature on this subject matter. The authors searched the PubMed database for publications containing the term "liver disease" in combination with "bone disease", "hepatic osteodistrophy", "osteoporosis", "osteopenia", "osteomalacia", and "fractures". They selected publications from the past 10 years but did not exclude older seminal publications, especially for colestatic liver diseases. This review of literature shows that osteoporosis crosses all CLD. It is important to underline that the progress of medicine and the new therapies stretched the disease's natural history and improved the survival of patients with CLD. It is fundamental to make better the quality of life and it is mandatory to prevent complications and in particular the osteoporotic ones, especially fractures.
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Affiliation(s)
- M Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - I Loperto
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - S Camera
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - V Cossiga
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - C Di Somma
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - N Caporaso
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy
| | - F Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, 5, 80131, Napoli, Italy.
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Librizzi MS, Guadalix S, Martínez-Díaz Guerra G, Allo G, Lora D, Jimenez C, Hawkins F. Trabecular bone score in patients with liver transplants after 1 year of risedronate treatment. Transpl Int 2016; 29:331-7. [DOI: 10.1111/tri.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/09/2015] [Accepted: 11/24/2015] [Indexed: 12/12/2022]
Affiliation(s)
- María Soledad Librizzi
- Metabolic Bone Disease Unit; Endocrinology Service; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Sonsoles Guadalix
- Metabolic Bone Disease Unit; Endocrinology Service; Hospital Universitario 12 de Octubre; Madrid Spain
| | | | - Gonzalo Allo
- Metabolic Bone Disease Unit; Endocrinology Service; Hospital Universitario 12 de Octubre; Madrid Spain
| | - David Lora
- Clinical Epidemiology Unit; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Carlos Jimenez
- Surgery Department; Hospital Universitario 12 de Octubre; Madrid Spain
| | - Federico Hawkins
- Metabolic Bone Disease Unit; Endocrinology Service; Hospital Universitario 12 de Octubre; Madrid Spain
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