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Chronic non-cholestatic liver disease is not associated with an increased fracture rate in children

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Abstract

Chronic liver disease in adults is a risk factor of osteoporosis, but little is known about risk of fractures in children with non-cholestatic liver disease. The aim of this study was to investigate associations among the severity of liver fibrosis, bone mass and low-energy fractures in children. History of fractures, anthropometry, and bone mass and size were examined in 39 Caucasian children (25 boys, 14 girls) aged 7.1–18 years (mean 11.9 ± 3.1) with chronic hepatitis B and liver fibrosis evidenced by liver biopsy. Severity of liver fibrosis was based on histological classification according to the method of Batts and Ludwig (mild, 1–2 scores; advanced, 3 scores) and Ishak (1–3 and 4–5 scores, respectively). Bone mineral content (BMC), density (BMD) and body composition were determined in the total body and lumbar spine using dual energy X-ray absorptiometry. Seven subjects (4 girls, 3 boys; 18% of the sample) had low BMD in the total body and lumbar spine region (Z-scores below −2.0). No associations were found among BMC, BMD, bone size and the severity of liver fibrosis. Nine boys (36% of all boys) and one girl reported repeated fractures (forearm, wrist, tibia, ankle, humerus), showing trends similar to the prevalence in general population. Fractures were neither associated with lower BMD/BMC nor with scores of liver fibrosis. Deficits in BMD in children with chronic hepatitis B are not associated with the severity of liver fibrosis. This study suggests that non-cholestatic liver disease does not increase the risk of low-energy fractures during growth. From the practical perspective, however, children with chronic liver disease should be screened for history and clinical risk factors for fractures rather than referred to bone density testing.

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Authors and Affiliations

  1. Department of Pediatrics and Developmental Disorders, Bone Densitometry Unit, ‘Dr. Ludwik Zamenhof’ University Children’s Hospital, Medical University of Bialystok, Waszyngtona St 17, 15274, Bialystok, Poland

    Jerzy Konstantynowicz, Pawel Abramowicz & Janina Piotrowska-Jastrzebska

  2. Department of Pediatric Gastroenetrology and Allergology, Medical University of Bialystok, Bialystok, Poland

    Dariusz M. Lebensztejn & Maciej Kaczmarski

  3. Department of Pediatric Oncology, Medical University of Bialystok, Bialystok, Poland

    Elzbieta Skiba

  4. Department of Clinical Pathomorphology, Medical University of Bialystok, Bialystok, Poland

    Maria E. Sobaniec-Lotowska

Authors
  1. Jerzy Konstantynowicz
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  2. Dariusz M. Lebensztejn
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  3. Elzbieta Skiba
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  4. Maria E. Sobaniec-Lotowska
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  5. Pawel Abramowicz
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  6. Janina Piotrowska-Jastrzebska
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  7. Maciej Kaczmarski
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Correspondence to Jerzy Konstantynowicz.

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Konstantynowicz, J., Lebensztejn, D.M., Skiba, E. et al. Chronic non-cholestatic liver disease is not associated with an increased fracture rate in children. J Bone Miner Metab 29, 315–320 (2011). https://doi.org/10.1007/s00774-010-0219-7

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  • DOI: https://doi.org/10.1007/s00774-010-0219-7

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