Saudi Journal of Gastroenterology

: 2019  |  Volume : 25  |  Issue : 3  |  Page : 201-

Bone mineral density loss in patients with cirrhosis

Mahmood Dhahir Al-Mendalawi 
 Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
P.O.Box 55302, Baghdad Post Office, Baghdad

How to cite this article:
Al-Mendalawi MD. Bone mineral density loss in patients with cirrhosis.Saudi J Gastroenterol 2019;25:201-201

How to cite this URL:
Al-Mendalawi MD. Bone mineral density loss in patients with cirrhosis. Saudi J Gastroenterol [serial online] 2019 [cited 2019 Sep 23 ];25:201-201
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I refer to the interesting study published by Muhsen et al. in SJG.[1] The authors found that cirrhotic patients are at increased risk of bone mineral density (BMD) loss at the lumber spine (LS) when compared to the general population. Out of the possible predictors tested (gender, age, body mass index, phosphorus, calcium, parathyroid hormone, vitamin D, and Model for End Stage Liver Disease [MELD] score), female gender was the main predictor of BMD loss at LS, highlighting the need for preventive measures especially for female patients.[1] The authors noted that the study was limited by its retrospective nature, as a temporal relationship between cirrhosis and BMD loss could not be made.[1] Additionally, I believe that the following methodological limitation may limit the accuracy of the study results. The authors mentioned that BMD was collected for both LS (L1–L4) and femoral neck (FN), and dual energy x-ray absorptiometry scan was used in measuring BMD. From World Health Organization (WHO) criteria, the results were then classified according to T-score into normal: –2.5 SD at both LS and FN.[1] It is obvious that BMD reference values (BMDRVs) are additionally controlled by various determinants namely age, gender, weight, pubertal stage, ethnicity and socio-economic standard.[2],[3] According to the aforementioned determinants, normative BMDRVs have been constructed for certain populations to be employed in the clinical field and research.[4] It is noteworthy that the Kingdom of Saudi Arabia is a pioneer in determining BMDRVs in healthy Saudis of both genders that underscored the importance of utilizing population-specific reference values for BMD estimations to avoid under diagnosis and/or over diagnosis of osteoporosis.[5] It remains unclear why the authors did not refer to the national BMDRV in their study. It can be assumed that employing them could better delineate BMD profile and its predictors in the Saudi patients with cirrhosis. Despite the study limitations, patients with cirrhosis need to be periodically checked for BMD loss and appropriate interventions planned should any osteoporosis or osteopenia be detected.

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1Muhsen IN, AlFreihi O, Abaalkhail F, AlKhenizan A, Khan M, Eldali A, et al. Bone mineral density loss in patients with cirrhosis. Saudi J Gastroenterol 2018;24:342-7.
2Arabi A, Nabulsi M, Maalouf J, Choucair M, Khalifé H, Vieth R, et al. Bone mineral density by age, gender, pubertal stages, and socioeconomic status in healthy Lebanese children and adolescents. Bone 2004;35:1169-79.
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5Ardawi MS, Maimany AA, Bahksh TM, Nasrat HA, Milaat WA, Al-Raddadi RM. Bone mineral density of the spine and femur in healthy Saudis. Osteoporos. Int 2005;16:43-55.