Zoledronic acid improves bone mineral density at the lumbar spine and total hip in adults with chronic liver disease.

INTRODUCTION

Chronic liver disease (CLD) is a known risk factor for osteoporosis and minimal trauma fracture through multiple mechanisms including cholestasis, alcohol, malnutrition, sarcopenia and hypogonadism. The evidence for bisphosphonates is mostly seen in primary biliary cholangitis and liver transplantation.

METHODS

This is a retrospective observational study of adult CLD patients, examining changes in bone mineral density (BMD) and bone turnover markers in the 12 months following zoledronic acid (ZA) compared to an age- and sex-matched population of CLD patients.

RESULTS

20 adults with CLD who received ZA were matched to 20 adults who had not received bone-specific treatment. Mean age of all participants was 59.7 ± 1.5 years and 55% were female. Baseline mean T-scores at the lumbar spine (LS) was -1.8 ± 1.3, left femoral neck (LFN) was -2.0 ± 0.9 and the left total hip (LTH) was -1.7 ± 1.0. There was a 3.61% difference in change in BMD per year at the LS (p=0.001) and 1.73% difference at the LTH between those who received ZA and those who did not (p=0.037). There was no difference at the LFN. In those who received ZA, mean change in procollagen type 1 N-propeptide was 3.0% p=0.051 and mean change in C-telopeptide was -10.4%, p= 0.032.

CONCLUSION

Zoledronic acid increases bone mineral density in a chronic liver disease population with reduction in bone resorption markers. This requires confirmation in a randomised setting.