Prevalence of Hepatic Osteodystrophy and Vitamin D Deficiency in Multi-Ethnic, End-Stage Liver Disease Patients of Mixed Etiologies, Awaiting Transplant

Presentation Number: MON 355
Date of Presentation: April 3rd, 2017

Huilin Koh*, Meifen Zhang, George Boon Bee Goh and Peng Chin Kek
Singapore General Hospital, Singapore, Singapore



Vitamin D deficiency and bone disease are known to be common in patients with liver cirrhosis.


The aims of this study were to investigate the prevalence of hepatic osteodystrophy and vitamin D deficiency in patients with end-stage liver disease awaiting liver transplantation.


This is a cross sectional study of pre-liver transplantation patients in a single-center cross-sectional study between May 2005 and December 2015. Data on demography, severity and etiology of liver disease, biochemical and bone densitometry, as well as risk factors for fractures were collected and analyzed.


Among the 204 patients (73% male), the mean age was 54±11years, with ethnic distribution of Chinese (82%), Malay (10%), Indian (7%), and other (1%). The mean severity of liver disease by model for end-stage liver disease (MELD) score was 18±11. The most common etiologies of liver disease were hepatitis B (49%), non-alcoholic steatohepatitis (10%), alcoholism (7%), cryptogenic (7%), primary biliary cirrhosis (7%) and hepatitis C (6%). Ninety-five patients (47%) had concomitant hepatocellular carcinoma (HCC). Indications for liver transplantation include recurrent HCC, progressive liver disease despite best medical therapy, and acute fulminant liver failure. We found a prevalence of osteoporosis (19%), osteopenia (54%), and normal bone density (27%), with corresponding MELD scores of 15±6, 14±7, and 13±6 respectively. Lower bone density did not correspond with higher MELD scores significantly (p=0.651). The mean 25-hydroxyvitamin D level for osteoporosis, osteopenia and normal bone density were 14±8, 17±9, and 14±6 ng/mL, respectively. Lower bone density also was not associated significantly with lower vitamin D levels (p=0.074). Six patients (3%) had previous fragility fractures. The mean 25-hydroxyvitamin D level was 14.7±8.1 ng/mL. The prevalence of vitamin D deficiency (≤20ng/mL) 74%, vitamin D insufficiency (20.1-30ng/mL) 22% and normal vitamin D levels (≥30.1ng/mL) 4% with corresponding MELD scores of 18±10, 10±4 and 11±8 respectively. A lower vitamin D status is associated with higher MELD scores (p=0.00000906).


There is a high prevalence of osteodystrophy and vitamin D deficiency in our population of pre-liver transplantation patients. The degree of vitamin D deficiency is associated with the severity of liver disease by MELD scoring.


Nothing to Disclose: HK, MZ, GBBG, PCK