Association of Sarcopenia and Bone Mineral Density in Patients with Chronic Liver Disease: A Prospective Cohort Study Using Standardised Scales.

INTRODUCTION

Patients with chronic liver diseases (CLD) are likely to have low bone mineral density (BMD) and sarcopenia, complicating frailty, fractures, and death. However, this relationship is not appropriately studied among South Asian individuals.

OBJECTIVES

The study aimed to establish the association between sarcopenia and BMD in CLD patients using standardised assessment tools.

METHODS

The proposed study is a prospective cohort study involving 501 adults with CLD in tertiary hospitals in Pakistan and collaborating international centers between December 2024 and July 2025. The baseline, 3 months and 6 months were used to determine the risk of sarcopenia and osteoporosis using the SARC-F and Osteoporosis Self-Assessment Tool for Asians (OSTA). Mann-Whitney U tests, repeated measures ANOVA and multiple linear regression were used to analyse data.

RESULTS

Men scored higher on SARC-F (p < 0.05), indicating a higher risk of sarcopenia, whereas women scored higher on OSTA (p < 0.05), indicating better bone health. Risks were also much higher at six months (F = 68.35 and 52.84, p < 0.001). Lower OSTA scores were predicted by higher SARC-F scores (B = -0.684, p < 0.001), older age, male sex, and longer disease duration, but physical activity was protective (B = 1.042, p < 0.001).

CONCLUSION

The loss of BMD is closely associated with sarcopenia in CLD. The musculoskeletal deterioration and better outcomes in this high-risk population can be achieved through early screening and interventions to encourage physical activity.