Severity of liver disease does not predict osteopenia or low bone mineral density in primary sclerosing cholangitis

Background: The association between metabolic bone disease and cholestatic liver disease has been poorly characterized. To date a single institution has published data suggesting that in primary sclerosing cholangitis (PSC), advanced liver disease predicts advanced bone disease. Aim: To determine the association between the severity of liver disease and bone mineral density (BMD) in PSC patients. Methods: We identified 30 PSC patients who had undergone dual energy X-ray absorptiometry (DXA) scan. We compared lumbar spine DXA scores between patients with more and less advanced liver disease. Results: Nine patients were osteopenic (30%), and one patient was osteoporotic. Five patients were female (17%), and none was postmenopausal. BMD was not different between patients listed and not listed for liver transplantation (P=0.49) or between patients with and without hepatic decompensation (P=0.63). Model for end-stage liver disease (MELD) score (P=0.99) and the modified Mayo risk score (P=0.25) did not predict BMD. Conclusions: Our study is the first to suggest that low bone density cannot be predicted by the severity of liver disease in PSC. Perhaps other known risk factors for osteoporosis will be important predictors of abnormal bone density in this patient population.