Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis

Marlene Reincke; Jochen Seufert; Katharina Laubner; Maximilian Meyer-Steenbuck; Anna Dammer; Lukas Sturm; Robert Thimme; Dominik Bettinger; Michael Schultheiss

doi:10.1016/j.dld.2024.04.009

Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis

Dig Liver Dis. 2024 Apr 27:S1590-8658(24)00710-2. doi: 10.1016/j.dld.2024.04.009. Online ahead of print.

Authors

Marlene Reincke¹, Jochen Seufert², Katharina Laubner³, Maximilian Meyer-Steenbuck¹, Anna Dammer¹, Lukas Sturm⁴, Robert Thimme¹, Dominik Bettinger¹, Michael Schultheiss⁵

Affiliations

¹ Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
² Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
³ Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.
⁴ Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.
⁵ Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany. Electronic address: michael.schultheiss@uniklinik-freiburg.de.

PMID: 38679509
DOI: 10.1016/j.dld.2024.04.009

Abstract

Background: Malnutrition is common in patients with cirrhosis, eventually leading to sarcopenia and loss of bone mass.

Aims: The aims of this study was the assessment of body composition (BC) and bone mineral density (BMD) in patients with decompensated cirrhosis and the prognostic impact on survival after transjugular intrahepatic portosystemic shunt (TIPS) implantation.

Methods: BMD and BC of 107 patients with cirrhosis undergoing TIPS implantation were prospectively analyzed by dual-energy X-ray absorptiometry. The prevalence and predisposing risk factors for reduced BMD and sarcopenia were assessed. Impact on 12-month survival after TIPS implantation was evaluated.

Results: Sarcopenia was diagnosed in 48.6 % of the patients with a predominance of male patients (58.7% vs. 25.0 %, p = 0.001). 67.2 % had reduced BMD. Low BMI was independently associated with sarcopenia (OR 0.751 (95 % CI: 0.662;0.852), p < 0.001) and reduced BMD (OR 0.851 (0.773;0.937), p = 0.001). Patients with reduced BMD, but not sarcopenia, had impaired 12-month survival after TIPS-implantation (61.2% vs. 82.9 %, p = 0.030). Subgroup analysis showed that this was especially valid for female patients.

Conclusions: Sarcopenia and reduced BMD are frequently observed in patients with decompensated cirrhosis. Reduced BMD negatively affects post-TIPS survival. Since malnutrition is a leading cause, assessment of nutritional status and specific treatment should be included in clinical practice.

Keywords: Bone mineral density; Decompensated cirrhosis; Osteoporosis; Sarcopenia; Transjugular intrahepatic portosystemic shunt.