High Prevalence of Hormonal Changes and Hepatic Osteodystrophy in Frail Patients with Cirrhosis—An Observational Study

Abstract

Hormonal changes and hepatic osteodystrophy are less often studied complications of cirrhosis. This study describes the variance in hormones and osteodystrophy between Frail and Not frail patients with cirrhosis. 116 outpatients with cirrhosis were prospectively enrolled in this study. Frailty assessment was done using Liver Frailty Index (LFI). Sociodemographic assessment, anthropometry, nutritional assessment, hormone profile, and dual-energy X-ray absorptiometryscan were done in all patients. 116 patients, predominantly males (100 (86.2%) with mean age of 50.16 years (95% CI, 48.43-51.89) were included. Malnutrition was more common in Frail group as compared to Not frail group. Subjective global assessment (SGA) class-B patients were significantly more in Frail group (37 (74%) vs 3 (4.5%), P= 0.001). The prevalence of lower parathyroid hormone (PTH) (14 (28%) vs 2 (3%)), testosterone (33 (66%) vs 15 (22.7%)), vitamin D3 (44 (88%) vs 39 (59.1%)), and cortisol (37 (74%) vs 37 (56.1) levels was higher in Frail group (P < 0.05). The number of patients diagnosed with osteodystrophy (34 (68%) vs 21 (31.8%), P= 0.001) was significantly higher in Frail group. The marker of osteoclastic activity, β-cross laps, was significantly elevated in the Frail group both in males (736 (655-818) vs 380 (329-432), P= 0.001) and (females 619 (479-758) vs 313 (83-543), P= 0.02). Bone mineral density (BMD) at lumbar spine (LS) and neck of femur (NF) had significant correlation with LFI (ρ= 0.60, P= 0.001 for LS and ρ= 0.59, P= 0.001 for NF), serum testosterone (ρ= 0.58, P= 0.001 for LS and ρ= 0.53, P= 0.001 for NF), β-cross laps (ρ= 0.38, P= 0.001for LS and ρ= 0.35, P= 0.000 for NF), vitamin D3 (ρ= 0.23, P= 0.04 for LS and ρ= 0.25, P= 0.01 for NF), PTH (ρ= 0.52, P= 0.001 for LS and ρ= 0.48. P= 0.001 for NF), and cortisol (ρ= 0.50, P= 0.001 for LS and ρ= 0.45, P= 0.001 for NF) levels. This is the first study that highlights the high prevalence of hormonal changes and hepatic osteodystrophy in frail patients with cirrhosis and opens a new dimension for research and target of therapy in this field.