Original article
Pancreas, biliary tract, and liver
A System to Determine Risk of Osteoporosis in Patients With Autoimmune Hepatitis

https://doi.org/10.1016/j.cgh.2019.05.043Get rights and content

Background & Aims

Osteoporosis is a feared complication of autoimmune hepatitis (AIH), but bone disease has not been well studied in these patients. We aimed to identify specific risk factors for osteoporosis in patients with AIH and to develop a scoring system that could be used to identify patients with increased risk of osteoporosis.

Methods

We performed a retrospective cross-sectional study of 211 patients (mean age, 56.8 years; 79.1% women) in Germany with a diagnosis of AIH from 2012 through 2017 and an indication for assessment of bone mineral status. The patients underwent bone mineral density measurements by dual energy X-ray absorptiometry. A subgroup of 99 patients underwent a second measurement. We used logistic regression to identify patient and clinical factors associated with the presence of osteoporosis. We developed a weighted sum score for estimating risk of osteoporosis and tested it in development (n = 141) and validation (n = 70) sets of patients.

Results

According to dual energy X-ray absorptiometry measurements, 15.6% of patients had osteoporosis 42.9% were in the range for osteopenia. The prevalence of osteoporosis in patients 50 years or older was 19.2%. Univariate and logistic regression analyses showed that age older than 54 years, duration of glucocorticoid use >90 months, body mass index <23 kg/m2 and transient elastography values >8 kPA increased risk of osteoporosis 13.8-fold, 6.2-fold, 5.9-fold, and 3.0-fold, respectively. Based on these factors, we developed an index that identified patients at low-, moderate-, and high-risk of osteoporosis with an area under the curve of 0.811. Of the patients with a second osteodensitometry measurement, the rate of bone loss progression ranged from 2.7% after 1 year to 8.4% after 7 years (mean bone loss, 1.2% per year).

Conclusions

Almost 20% of patients with AIH older than 50 years have osteoporosis. Older age, duration of corticosteroid use, low body mass index, and liver fibrosis are independent risk factors for bone loss.

Section snippets

Study Design and Ethics Statement

Between 2012 and 2017, a total of 211 adult patients with a diagnosis of AIH were identified at our academic tertiary care hospital (University Medical Center Hamburg-Eppendorf, Hamburg, Germany) who also had at least 1 dual-energy x-ray absorptiometry (DXA) measurement. All patients had a clinical indication according to the evidence-based (S3) guideline for osteoporosis of the German Association of Osteology and the official position of the International Society for Clinical Densitometry.

Demographic and Disease Characteristics of the Study Cohort

The cross-sectional study cohort consisted of 211 consecutive patients diagnosed with AIH that were identified to have had at least 1 BMD measurement at our institution from 2012 to 2017. At the time point of DXA measurement, the mean age of patients was 56.8 (range, 18–93) years. The majority (79.1%) were women, the mean BMI was 27.1 kg/m2, and the mean duration of disease was 91.8 months. Seventeen (8.1%) patients also had additional signs of PBC (variant syndrome). Moreover, 37 (17.5%)

Discussion

This is the largest study investigating the prevalence of osteoporosis in patients with AIH. Overall, osteoporosis was prevalent in 15.6% of AIH patients, while the prevalence of osteoporosis in patients ≥50 years of age was 19.2%. However, the study has some limitations due to its retrospective design and the patient selection for DXA measurement, which was based on medical indication. A total of 241 other AIH patients who were seen at our institution during 2012–2017 did not receive DXA

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Conflicts of interest The authors disclose no conflicts.

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Authors share co-first authorship.

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