Liver cirrhosis increases the risk of osteoporosis and fractures: BMC Study

A new study published in the journal of BMC Gasteroenterology found that patients with the liver cirrhosis had higher risk of osteoporosis and a more than 2-fold higher risk of fractures when compared to people without liver cirrhosis.

Low bone mass (bone mineral density (BMD) T-score <− 2.5) and bone tissue structural abnormalities are hallmarks of osteoporosis, which increases the risk of fractures and skeletal fragility. There are 2 types of osteoporosis one being primary, which occurs in menopausal women and the elderly, and the secondary, which can be brought on by a number of illnesses or drugs.

One of the diseases linked to secondary osteoporosis is hepatic cirrhosis. Hospitalizations, incidence fractures, recovery times, morbidity and mortality, and medical expenses can all rise as a result of osteoporosis. These issues can significantly impair the quality of life for those who have cirrhosis as well as the healthcare system, which emphasizes how critical it is to comprehend and treat bone health in this group. The objective of this study was to examine the risk of osteoporosis, fractures, and alterations in bone mineral density between patients with hepatic cirrhosis and healthy, non-cirrhotic controls.

Studies from MEDLINE/PubMed, Web of Science, Scopus, and Embase up until July 2024 were sourced in accordance with PRISMA criteria. These included observational studies that evaluated osteoporosis, fracture, and BMD in individuals with cirrhosis as opposed to those without. Standardized mean differences (SMD) and odds ratios (OR) of outcomes were computed for meta-analyses. To investigate the robustness and sources of heterogeneity, sensitivity analyses and meta-regression were also carried out.

Almost, 21 studies including 6,95,330 control individuals and 76,521 cirrhotic patients were included in the study. The patients with cirrhosis had noticeably greater probabilities of developing osteoporosis. With an OR of 2.30 for cirrhotic individuals, fracture was noticeably higher.

Both the lumbar spine and the femoral neck showed decreases in BMD. These results were validated by sensitivity analyses, and meta-regression showed that the presence of men affected these correlations in different ways. Overall, considering hepatic cirrhosis is linked to a markedly elevated risk of osteoporosis and fractures, it is crucial to incorporate cirrhosis into clinical fracture-risk models as well as focused screening and prevention initiatives.

Reference:

Shirinezhad, A., Eshlaghi, F. M., Salabat, D., Azarboo, A., Ardakani, Z. F., Esmaeili, S., Amir Human Hoveidaei, & Ghaseminejad-Raeini, A. (2025). Prevalent osteoporosis and fracture risk in patients with hepatic cirrhosis: a systematic review and meta-analysis. BMC Gastroenterology, 25(1). https://doi.org/10.1186/s12876-025-03720-6