The routine assessment of postmenopausal women involves screening for cardiometabolic risk factors and bone health. Evaluation of the liver function is not commonly performed, even though this could be easily performed with the use of indirect markers, such as the Fibrosis 4 score. Recent evidence supports an association between liver cirrhosis and bone turnover, affecting both the trabecular and the cortical bone. Therefore, we aimed to explore the possible link between postmenopausal osteoporosis and liver function, expressed according to the values of the Fibrosis 4 (Fib4) score.
This was a cross-sectional study of 8.363 postmenopausal women, retrieved from a University Menopause Clinic. Details of the personal and medical history were retrieved from the departmental database, including osteoprotective drug intake. Participants underwent a fasting blood test, in the context of their routine assessment in the Department, for estimation of biochemical and hormonal parameters. Moreover, we performed a bone density scan (DEXA) of either the lumbar spine (LS) or the femoral neck (FN) for evaluation of possible underlying osteoporosis.
Mean age of our women was 56.7 ± 7.5 years, with a mean menopausal age of 8.87 ± 6.9 years and BMI 26.9 ± 4.7 kg/m2. Correlation analysis between Fib4 values and bone parameters was as follows: LS-BMD, r = –0.083; LS-Tscore = –0.099; FN-BMD, r = –0.085; FN-Tscore r = –0.093, P-value < 0.001 in all cases. The presence of osteoporosis in the lumbar spine only was associated with higher values of Fib4 score (1.14 ± 0.35 vs 1.08 ± 0.49, F = 5.509, P-value = 0.019, ANCOVA adjusted for age, menopausal age, BMI, smoking, alcohol, intake of calcium/bisphosphonates, type 2 diabetes, thyroid-stimulating hormone levels). Fib4 values > 1.45 vs lower levels were associated with 2.147 times higher risk for LS-osteoporosis (P-value = 0.001) in combination with the effect of age, calcium/bisphosphonates intake, BMI and HDL cholesterol. No associations were observed between FN-osteoporosis and values of Fib4 score either in dichotomous or continuous manner.
These results are indicative of lower BMD in patients with higher values of Fib4 score, affecting particularly the LS-region. These findings are compatible with data available on patients with established cirrhosis. Differences between the lumbar and femoral skeletal region with regards to the amount of trabecular bone might be an explanation of the differing associations observed in this study. Further case-control studies are needed to confirm these findings.
22 May 2021 - 26 May 2021