Examination of bone mineral density in patients with varied liver diseases - a cross-sectional study

doi:10.4254/wjh.120697

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. Aug 27, 2026; 18(8): 120697
Published online Aug 27, 2026. doi: 10.4254/wjh.120697

Table 1 Patient demographics, median (interquartile range)

Group	n	Median age	Female	Male	BMI (kg/m²)	Liver function panel	MELD-score	Child-Pugh score	Bisphosphonate use
PBC	15	64 (57-72)	11	4	28	ALT: 68 (45-92) U/L	14 (11-17)	8 (7-9) (class B)	6
						γ-GT: 460 (320-590) U/L
						Bilirubin: 3.2 (2.1-4.8) mg/dL
PSC	22	49 (42-63)	7	15	22	ALT: 74 (50-108) U/L	-	7 (6-9) (class B)	3
						γ-GT: 410 (280-570) U/L
						Bilirubin: 2.8 (1.9-4.3) mg/dL
HCV	11	66 (64-75)	7	4	27	ALT: 74 (52-106) U/L	-	6 (5-7) (class A)	3
						γ-GT: 220 (150-310) U/L
						Bilirubin: 2.0 (1.3-3.1) mg/dL
AIH	13	63 (53-70)	10	3	26	ALT: 102 (84-155) U/L	-	7 (6-8) (class B)	2
						γ-GT: 310 (220-420) U/L
						Bilirubin: 2.5 (1.4-3.9) mg/dL
Cysts	21	57 (49-63)	18	3	24	ALT: 45 (30-60) U/L	-	5 (5-6) (class A)	1
						γ-GT: 110 (85-150) U/L
						Bilirubin: 0.9 (0.5-1.4) mg/dL
Control	101	50 (48-53)	16	85	27	Within normal range	-	-	-

Baseline demographic characteristics of patients with different etiologies of end-stage liver disease and healthy controls. PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis; Cysts: Hepatic cystic disease; Control: Healthy control group; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; ALT: Alanin aminotransferase; γ-GT: Gamma-glutamyl transferase.

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Table 2 Bone mineral density and T-scores

Parameter	PBC	P value PBC	PSC	P value PSC	AIH	P value AIH	HCV	P value HCV	Cysts	P value cysts	Control
BMD right femoral neck	0.91 (0.81; 0.96)	0.01	0.96 (0.91; 1.05)	0.3	0.93 (0.86; 0.99)	0.07	0.79 (0.72; 1.06)	0.1	0.93 (0.85; 1.04)	0.03	0.99 (0.92; 1.09)
T-score right femoral neck	-0.8 (-1.7; -0.3)	0.13	-0.5 (-1.4; -0.2)	0.49	-0.4 (-1.1; 0.3)	0.74	-1.7 (-2.4; -0.2)	0.07	-0.7 (-1.6; 0.1)	0.29	-0.5 (-1.1; 0.2)
BMD left femoral neck	0.88 (0.63; 0.95)	0.0	0.94 (0.87; 1.05)	0.06	0.92 (0.86; 1.04)	0.14	0.98 (0.78; 1.02)	0.25	0.94 (0.84; 1.04)	0.06	0.99 (0.92; 1.08)
T-score left femoral neck	-1.3 (-2.7; -0.4)	0.01	-0.7 (-1.4; -0.1)	0.09	-0.4(-1.2; 0.2)	0.99	-0.6 (-1.7; 1.0)	0.31	-0.7 (-1.5; 0.3)	0.33	-0.5 (-1.1; 0.2)
BMD lumbar spine	0.92 (0.74; 1.10)	0.0	0.95 (0.88; 1.01)	0.0	1.01 (0.93; 1.21)	0.01	0.94 (0.84; 1.00)	0.0	0.93 (0.80; 1.02)	0.0	1.21 (1.09; 1.30)
T-score lumbar spine	-2.5 (-3.1; -0.8)	0.0	-2.1 (-2.6; -1.2)	0.0	-1.1 (-2.1; 0.7)	0.08	-1.8 (-2.9; -0.6)	0.0	-1.9 (-3.0; -0.2)	0.0	-0.1 (-1.0; 0.6)

PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis; Cysts: Hepatic cystic disease; Control: Healthy control group; BMD: Bone mineral density.

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Table 3 Bone metabolism markers

Marker	PBC	PSC	AIH	HCV	Cysts
Osteocalcin (ng/mL)	14.2	17.2	14.9	14.6	61.9
25-OH vitamin D (nmol/L)	142.4	60.3	49.9	45.9	79.0
PTH (ng/L)	34.7	39.0	44.8	49.7	85.8
Phosphate (mmol/L)	1.1	1.0	1.0	2.1	1.1
Copper (μmol/L)	25.8	27.6	19.9	18.8	27.5
Zinc (μmol/L)	7.1	8.8	8.0	7.6	9.8
Magnesium (mmol/L)	0.8	0.8	0.8	0.8	0.8
Calcium (mmol/L)	2.3	2.3	2.3	2.1	2.3
Creatinine (μmol/L)	88	95	83	91	310¹
AST (U/L)	85	74	121	98	63
ALT (U/L)	72	69	115	104	52

¹Several patients with hepatic cysts presented with concomitant polycystic kidney disease and dialysis-dependent renal failure, explaining the markedly elevated creatinine levels. PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis; Cysts: Hepatic cystic disease; PTH: Parathyroid hormone; AST: Aspartat aminotransferase; ALT: Alanin aminotransferase.

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Table 4 Correlation between bone mineral density parameters and liver function scores

Variable pair	Spearman’s ρ	Interpretation
Lumbar spine T-score vs MELD	-0.01	No correlation
Lumbar spine T-score vs Child-Pugh	+0.12	Weak positive, not significant
Lumbar spine BMD vs MELD	-0.06	No correlation
Lumbar spine BMD vs Child-Pugh	+0.09	Weak positive, not significant
Right femoral neck T-score vs MELD	+0.04	No correlation
Right femoral neck T-score vs Child-Pugh	+0.09	Weak positive
Right femoral neck BMD vs MELD	+0.01	No correlation
Right femoral neck BMD vs Child-Pugh	+0.01	No correlation
Left femoral neck T-score vs MELD	-0.02	No correlation
Left femoral neck T-score vs Child-Pugh	+0.06	Weak positive
Left femoral neck BMD vs MELD	-0.01	No correlation
Left femoral neck BMD vs Child-Pugh	+0.02	No correlation
Lumbar spine T-score vs MELD	-0.01	No correlation
Lumbar spine T-score vs Child-Pugh	+0.12	Weak positive, not significant
Lumbar spine BMD vs MELD	-0.06	No correlation
Lumbar spine BMD vs Child-Pugh	+0.09	Weak positive, not significant
Right femoral neck T-score vs MELD	+0.04	No correlation
Right femoral neck T-score vs Child-Pugh	+0.09	Weak positive
Right femoral neck BMD vs MELD	+0.01	No correlation
Right femoral neck BMD vs Child-Pugh	+0.01	No correlation
Left femoral neck T-score vs MELD	-0.02	No correlation
Left femoral neck T-score vs Child-Pugh	+0.06	Weak positive
Left femoral neck BMD vs MELD	-0.01	No correlation
Left femoral neck BMD vs Child-Pugh	+0.02	No correlation

Spearman’s rank correlation coefficients (ρ) were calculated to assess the association between bone parameters (bone mineral density and T-scores at the lumbar spine and femoral neck) and liver function indices. No significant correlations were found between bone density measures and either Model of End-Stage Liver Disease or Child-Pugh scores. Weak, non-significant positive trends were observed between T-scores and Child-Pugh classification, indicating a potential but clinically minor association between better hepatic function and higher bone density. MELD: Model of End-Stage Liver Disease; BMD: Bone mineral density.

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Table 5 Match-pair analysis of bone mineral density and T-scores in liver transplant recipients with and without osteoporotic fractures

Parameter	Test	n	Mean fracture	Mean control	P value
T-score lumbar spine	Wilcoxon	7	-3.07	-1.29	0.08
BMD lumbar spine	Wilcoxon	6	0.81	0.95	0.16
T-score left femoral neck	Wilcoxon	6	-1.9	-0.82	0.16
BMD left femoral neck	Wilcoxon	6	0.77	0.94	0.09

Comparison of lumbar spine and femoral neck bone parameters between patients with documented osteoporotic fractures and matched fracture-free controls. Matching was performed 1:1 based on age, sex, body mass index, Model of End-Stage Liver Disease score, serum 25-hydroxyvitamin D, parathyroid hormone, and osteocalcin levels. BMD: Bone mineral density.

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Table 6 Match-pair analysis using Wilcoxon signed-rank test in 1:1 matched pairs

Parameter	Test	n	Mean fracture	Mean control	P value
T-score (lumbar spine)	Wilcoxon	7	-3.07	-1.29	0.08
BMD (lumbar spine)	Wilcoxon	6	0.81 g/cm²	0.95 g/cm²	0.16
T-score (left femoral neck)	Wilcoxon	6	-1.90	-0.82	0.16
BMD (left femoral neck)	Wilcoxon	6	0.77 g/cm²	0.94 g/cm²	0.09

Detailed comparison of T-scores and bone mineral density values at the lumbar spine and left femoral neck between fracture and control groups. Bone mineral density, expressed in g/cm²; T-score = standard deviation from the mean peak bone mass of a healthy young adult population. Matching criteria: Age, sex, body mass index, Model of End-Stage Liver Disease score, serum 25-hydroxyvitamin D, parathyroid hormone, and osteocalcin levels. All comparisons used the Wilcoxon signed-rank test for paired data. BMD: Bone mineral density.

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Table 7 Regression coefficients for bone mineral density lumbar spine

Predictor	Regression coefficient (β)	P value	95%CI (lower bound)	95%CI (higher bound)	Standardized coefficient (β-standardized)
Sex (male)	-0.0159	0.7681	-0.1231	0.0914	-0.0414
Age (per year)	-0.0046	0.0215	-0.0084	-0.0007	-0.3115
BMI (kg/m²)	0.0121	0.0202	2	0.0223	0.3162
MELD score	-0.0046	0.4076	-0.0155	0.0064	-0.1312
Child-Pugh (points)	0.0082	0.6788	-31	0.0474	0.0726
PBC	0.1079	0.0917	-18	0.2338	-0.1033
PSC	0.1766	0.0002	0.0878	0.2655	0.0473
HCV	0.18	0.0129	0.0395	0.3205	0.0382
AIH	0.1775	0.0038	0.0596	0.2955	0.0387
Polycystic liver disease	0.1495	0.0023	0.0557	0.2433	-0.0209

Results from multiple linear regression identifying independent predictors of areal lumbar spine bone mineral density (g/cm²). CI: Confidence interval; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis.

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Table 8 Regression coefficients for T-score lumbar spine

Predictor	Regression coefficient (β)	P value	95%CI (lower bound)	95%CI (higher bound)	Standardized coefficient (β-standardized)
Sex (male)	-0.4431	0.3909	-1.4671	0.5809	-0.1138
Age (per year)	-0.0045	0.8165	-0.0432	0.0341	-0.0312
BMI (kg/m²)	0.0753	0.1503	-28	0.1785	0.1906
MELD score	-38	0.4853	-0.1459	0.07	-0.1049
Child-Pugh (points)	0.1194	531	-259	0.4978	106
PBC	-1.3522	0.0379	-2.6265	-0.0778	-0.18
PSC	-0.4625	297	-1.3406	0.4156	0.0009
HCV	-0.7389	0.2776	-2.086	0.6083	-0.0497
AIH	0.2416	678	-0.9144	1.3977	0.1437
Polycystic liver disease	-0.1799	701	-1.1112	0.7513	0.0681

Results from multiple linear regression identifying independent predictors of areal lumbar spine for T-score. CI: Confidence interval; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis.

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Table 9 Regression coefficients for bone mineral density left femoral neck

Predictor	Regression coefficient (β)	P value	95%CI (lower bound)	95%CI (higher bound)	Standardized coefficient (β-standardized)
Sex (male)	-0.0047	0.9122	-0.0897	0.0803	-0.0147
Age (per year)	-0.0027	0.0914	-0.0058	0.0004	-0.2182
BMI (kg/m²)	0.0121	0.0052	0.0038	0.0204	0.3727
MELD score	-0.0	0.9918	-0.0091	9	-0.0016
Child-Pugh (points)	-0.0056	729	-38	0.0267	-0.0593
PBC	0.0241	0.6421	-0.0789	0.1271	-0.2673
PSC	0.1671	0.0	0.0956	0.2386	0.1003
HCV	0.1548	0.0088	0.0404	0.2693	0.0432
AIH	0.1428	0.0044	0.0462	0.2394	0.0213
Cystic disease	0.1591	0.0001	0.0828	0.2355	73

Results from multiple linear regression identifying independent predictors of areal left femoral neck bone mineral density (g/cm²). CI: Confidence interval; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis.

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Table 10 Regression coefficients for bone mineral density right femoral neck

Predictor	Regression coefficient (β)	P value	95%CI (lower)	95%CI (upper)	Standardized coefficient (β-standardized)
Sex (male)	-9	0.86	-0.1	0.08	-15
Age (years)	-0.0029	0.08	-6	0.0003	-0.22
BMI (kg/m²)	0.0124	4	4	21	0.37
MELD score	0.0002	0.94	-8	9	-2
Child-Pugh (points)	-6	0.71	-38	26	-0.06
PBC	-0.11	0.07	-0.23	0.01	-0.27
PSC	0.03	0.66	-0.1	0.15	0.1
HCV	0.01	0.89	-0.13	0.15	0.04
Cystic disease	0.02	0.8	-0.11	0.14	0.07

Results from multiple linear regression identifying independent predictors of areal right femoral neck bone mineral density (g/cm²). CI: Confidence interval; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus infection; AIH: Autoimmune hepatitis.

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Citation: Rohland O, Schwarzer L, Schwenk L, Pollmann N, Ali Deeb A, Settmacher U, Rauchfuss F, Dondorf F, Amrein K, Kocijan R, Ardelt M. Examination of bone mineral density in patients with varied liver diseases - a cross-sectional study. World J Hepatol 2026; 18(8): 120697
URL: https://www.wjgnet.com/1948-5182/full/v18/i8/120697.htm
DOI: https://dx.doi.org/10.4254/wjh.120697

Rohland O, Schwarzer L, Schwenk L, Pollmann N, Ali Deeb A, Settmacher U, Rauchfuss F, Dondorf F, Amrein K, Kocijan R, Ardelt M. Examination of bone mineral density in patients with varied liver diseases - a cross-sectional study. World J Hepatol 2026; 18(8): 120697 [DOI: 10.4254/wjh.120697]

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