Correlation analysis of sarcopenia, osteoporosis, and vertebral fragility fracture in patients with liver cirrhosis using QCT

Background: Sarcopenia, osteoporosis (OP), and vertebral fragility fractures were common in patients with LC. This study aimed to investigate the correlation between sarcopenia, OP, and vertebra fragility fracture in patients with liver cirrhosis (LC) using quantitative computed tomography (QCT). Methods: Participants included 365 patients with LC and 130 age- and gender-matched controls who underwent an abdominal noncontrast CT scans at our Hospital from July 2019 to September 2022. The skeletal muscle area at the L3 vertebra (SMA-L3), muscle fat infiltration in posterior muscle groups at the L3 vertebra (MFI-L3), and lumbar bone mineral density (BMD) were measured using QCT Pro software. The skeletal muscle index at the L3 vertebra (SMI-L3) was SMA-L3/height². Sarcopenia was diagnosed based on SMI-L3 < 50cm²/m² (male), SMI-L3 < 39cm²/m² (female). Results: Patients with LC had lower SMI-L3 and lumbar BMD than controls ( P  < 0.05), along with the higher prevalence of OP (26.00% vs. 16.20%), fracture (18.60% vs. 9.20%), and MFI-L3 than controls ( P  < 0.05). In patients with LC, logistic regression analysis indicated that age, Child-Pugh C, and OP were risk factors for sarcopenia ( P  < 0.05), while body mass index (BMI) was a protective factor (P < 0.001). Furthermore, female, age, sarcopenia, and fracture were risk factors for OP ( P  < 0.05), and age and OP were risk factors for fracture ( P  < 0.001). Conclusions: Our study further extended the application value of QCT without additional patient exposure to ionizing radiation including assessment of BMD and muscle tissue. Sarcopenia, OP, and vertebral fragility fractures were closely correlated with each other.