NEW data has identified bone mineral density (BMD) as a potentially novel risk factor and early predictor for cirrhosis development. The bidirectional interplay between liver metabolism and bone metabolism is known as the liver–bone axis, with osteoporosis recognised as a common complication of cirrhosis.
Previous studies examining the liver-bone axis focused primarily on the impact of liver disease on bone mass. However, a research team from the University of Hong Kong, Hong Kong, followed 7,752 participants in a prospective cohort study measuring BMD to investigate the relationship between BMD and the risk of incident cirrhosis.
In the Hong Kong Osteoporosis Study, BMD was measured at the lumbar spine, femoral neck, total hip, and trochanter through dual-energy X-ray absorptiometry. The incidence of cirrhosis and mortality was collected from the territory-wide electronic health records database. Study participants were tracked until incident cirrhosis, death, or study completion in June 2022.
The median follow-up was 18.43 years, with 42 incidents of cirrhosis recorded within the cohort. Results from 6,866 adults with no reported risk factors of cirrhosis, and higher BMD T-scores in the femoral neck (adjusted hazard ratio [aHR]: 0.57; 95% CI: 0.37–0.86; P=0.008), total hip (aHR: 0.61; 95% CI: 0.43–0.87; P=0.007), and trochanter (aHR: 0.63; 95% CI: 0.43–0.91; P=0.014), were associated with decreased risk of cirrhosis, with each one-point increase in BMD T-scores leading to a decrease in cirrhosis risk. On the other hand, sensitivity analyses revealed that BMD T-scores of less than -2.5 contributed to an increased risk of cirrhosis development when compared with BMD T-scores greater than -1 (HR: 3.57; 95% CI: 1.15–11.09).
These findings led the study lead, Ching-Lung Cheung, University of Hong Kong, Hong Kong, and contributors, to conclude the potential role of osteoporosis in the deterioration of liver function, possibly preceding the onset of cirrhosis. Finally, the research team highlighted the need for future studies in more diverse populations to validate their findings and “expand our understanding of the liver-bone axis beyond the conventional focus.”
Reference
Zhang X et al. Low bone mineral density as a risk factor for liver cirrhosis: a prospective cohort study. J Clin Endocrinol Metab. 2024;DOI:10.1210/clinem/dgae223.
