Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4038
Peer-review started: September 15, 2014
First decision: October 14, 2014
Revised: October 17, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
AIM: To evaluate the association between alcoholic liver disease (ALD) and bone fractures or osteoporosis.
METHODS: Non-randomized studies were identified from databases (PubMed, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included “alcoholic liver diseases”, “osteoporosis”, or “bone fractures”. The prevalence of any fractures or osteoporosis, and bone mineral density (BMD) were extracted and analyzed using risk ratios and standardized mean difference (SMD). A random effects model was applied.
RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944 (95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849 (95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD (SMD in femur-BMD: -0.172, 95%CI: -0.453-0.110; SMD in spine-BMD: -0.169, 95%CI: -0.476-0.138). Sensitivity analyses showed consistent results.
CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.
Core tip: Excessive alcohol consumption is a well-established risk factor for osteoporosis and bone fractures. However, light amounts of alcohol ingestion is known to be associated with higher bone mineral density (BMD) and low fracture rates. This study evaluated the current evidence regarding osteoporosis and bone fractures in alcoholic liver disease (ALD). In this meta-analysis, there was significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis. Although the mechanism of bone fractures in ALD is not totally understood, further research utilizing a homogenous population and controlling for confounding risk factors for fractures could elucidate the mechanism.