Osteoporosis and bone fractures in alcoholic liver disease: A meta-analysis

Table 1 Clinical data of included studies

Ref.	Population characteristics	LC in ALD	Bone fractures					Osteoporosis				ALD BMD	Control BMD
			Fracture site	ALD fracture	Total ALD	Control fracture	Total control	ALD osteoporosis	Total ALD	Control osteoporosis	Total control
Lindsell et al[44]	149 CLD (72 ALD, 77 non-alcoholic CLD), 149 normal controls	0	Rib or clavicle	18	72	10	149 (normal control)
Diamond et al[46]	115 CLD (M: 72, F: 43), 113 Controls (M: 52, F: 61)	Unidentifiable	Peripheral bone	12	40	12	75 (other CLD)
Bonkovsky et al[23]	133 CLD (M: 70, F: 63, Mean age: 47 ± 1.1)	Unidentifiable						5 (L), 4 (FN)	32	15 (L), 5 (FN)	48 (other LC)
Ninkovic et al[39]	37 CLD (6 ALD, 31 other CLD) (M: 20, F: 17, Mean age: 51.3, range: 32-65)	Unidentifiable	Vertebra	6	6	17	31 (other CLD)
Ninkovic et al[21]	243 CLD (M: 128, F: 115, Mean age: 51.1 ± 10.9)	Predominantly LC			46		55 (HCV)					T (L1-4): -0.94 ± 1.38, T (FN): -1.49 ± 1.15	T (L1-4): -1.59 ± 1.6, T (FN): -1.66 ± 1.27
Carey et al[45]	207 CLD (66 ALD, 73 HCV + ALD, 68 HCV) (M: 131, F: 76, Mean age: 51, range: 32-68)	Unidentifiable	Overall fractures	21	66	13	68 (HCV)	12	66	19	68 (HCV)	T (L1-4): -0.87 ± 1.61	T (L1-4): -1.43 ± 1.68
Kim et al[47]	18 ALD (Mean age: 50.2 ± 9.5), 18 normal controls (Mean age: 51.2 ± 14)	0						4	18	3	18 (normal control)	T (L2-4): 1.04 ± 0.14, T (FN): 0.844 ± 0.12	T (L2-4): 1.131 ± 0.22, T (FN): 0.908 ± 0.15
Sokhi et al[22]	104 CLD (M: 54, F: 50, Mean age: 54.4 ± 12.9)	All (17)			17		69 (LC-HCV)					T (L2-4): -1.17 ± 0.16, T (FN): 0.97 ± 0.18	T (L2-4): 1.23 ± 0.25, T (FN): 0.98 ± 0.16
Alvisa-Negrín et al[43]	77 ALD (M: 68, F: 9, Mean age: 50.43 ± 10.81), 28 normal controls (M: 25, F: 3, Mean age: 49.83 ± 9.24)	41 ALC, 30 Non-LC						9	77	0	28 (normal control)	1T (L): -1.2 ± 1.16, T (FN): -1.1 ± 1.28	1T (L): -0.49 ± 0.89, T (FN): -0.5 ± 1.23
González-Reimers et al[40]	124 ALD (Mean age: 50.5 ± 11.23), 38 Controls (Mean age: 48.47 ± 11.08)	51 ALC, 61 Non-LC			124		38 (normal control)					2T (LS): -1.17 ± 1.22, T (FN): -1.24 ± 1.38	2T (LS): -0.5 ± 0.86, T (FN): -0.36 ± 1.34
Mitchell et al[24]	117 CLD (M: 74, F: 43, Mean age: 50.4 ± 10.5)	Unidentifiable			20		46 (viral CLD)					T (L1-4): -1.51 ± 1.35, T (FN): -1.31 ± 1.02	T (L1-4): -1.08 ± 1.35, T (FN): -1.11 ± 1.07
Mahmoudi et al[25]	109 CLD (M: 72, mean age: 55.3 ± 11.4, F: 37, mean age: 65.2 ± 11)	All (31)			31		43 (LC-HCV)					T (L1-4): -0.34 ± 1.46, T (FN): -0.07 ± 1.45	T (L1-4): -0.83 ± 1.66, T (FN): -0.56 ± 1.49
Wibaux et al[42]	99 CLD (M: 79, F: 20, mean age: 55 ± 8)	All (39)	Vertebra	17	39	19	60 (other CLD)
Choudhary et al[26]	115 LC (M: 107, F: 8, mean age: 49 ± 5.5)	All (67)						16	67	10	48 (viral LC)
González-Reimers et al[41]	90 ALD (Mean age: 50.14 ± 10.49), 30 normal controls (Mean age: 50.11 ± 10.4)	40 ALC, 48 Non-LC	Overall fractures	49	90	0	30 (normal control)					3T (L): -1.15 ± 1.18	3T (L): -0.56 ± 0.9

¹Measured only in 23 patients for each group;

²Measured in 117 patients with ALD and 24 patients in control group;

³Measured in 85 patients with ALD and 28 patients in control group. LC: Liver cirrhosis; ALD: Alcoholic liver disease; BMD: Bone mineral density; CLD: Chronic liver disease; Other CLD: CLD of etiology other than alcohol; L: Lumbar spine, FN: Femoral neck bone; Other LC: Liver cirrhosis of etiology other than alcohol; HCV: Chronic hepatitis C.

Table 2 Methodological quality of included studies measured by Newcastle-Ottawa scale

Study	Selection	Comparability	Exposure or outcome	Total
Lindsell et al[44]	2		3	5
Diamond et al[46]	3	1	3	7
Bonkovsky et al[23]	3		2	5
Ninkovic et al[39]	4		3	7
Ninkovic et al[21]	3		3	6
Carey et al[45]	3	1	3	7
Kim et al[47]	3	2	3	8
Sokhi et al[22]	3		3	6
Alvisa-Negrín et al[43]	3	1	2	6
González-Reimers et al[40]	3	1	3	7
Mitchell et al[24]	3		3	6
Mahmoudi et al[25]	3		3	6
Wibaux et al[42]	3		3	6
Choudhary et al[26]	3	2	3	8
González-Reimers et al[41]	3	1	2	6