BACKGROUND & AIMS Osteoporosis is a feared complication of autoimmune hepatitis (AIH), but bone disease has not been well studied in these patients. We aimed to identify specific risk factors for osteoporosis in patients with AIH and to develop a scoring system that could be used to identify patients with increased risk of osteoporosis. METHODS We performed a retrospective cross-sectional study of 211 patients (mean age, 56.8 years; 79.1% women) in Germany with a diagnosis of AIH from 2012 through 2017 and an indication for assessment of bone mineral status. The patients underwent bone mineral density measurements by dual energy X-ray absorptiometry. A subgroup of 99 patients underwent a second measurement. We used logistic regression to identify patient and clinical factors associated with the presence of osteoporosis. We developed a weighted sum score for estimating risk of osteoporosis and tested it in development (n = 141) and validation (n = 70) sets of patients. RESULTS According to dual energy X-ray absorptiometry measurements, 15.6% of patients had osteoporosis 42.9% were in the range for osteopenia. The prevalence of osteoporosis in patients 50 years or older was 19.2%. Univariate and logistic regression analyses showed that age older than 54 years, duration of glucocorticoid use >90 months, body mass index <23 kg/m2 and transient elastography values >8 kPA increased risk of osteoporosis 13.8-fold, 6.2-fold, 5.9-fold, and 3.0-fold, respectively. Based on these factors, we developed an index that identified patients at low-, moderate-, and high-risk of osteoporosis with an area under the curve of 0.811. Of the patients with a second osteodensitometry measurement, the rate of bone loss progression ranged from 2.7% after 1 year to 8.4% after 7 years (mean bone loss, 1.2% per year). CONCLUSIONS Almost 20% of patients with AIH older than 50 years have osteoporosis. Older age, duration of corticosteroid use, low body mass index, and liver fibrosis are independent risk factors for bone loss.

中文翻译：

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一种确定自身免疫性肝炎患者骨质疏松症风险的系统。

背景与目的骨质疏松症是一种令人恐惧的自身免疫性肝炎（AIH）并发症，但尚未在这些患者中充分研究其骨病。我们旨在确定AIH患者骨质疏松症的具体危险因素，并开发一种评分系统，可用于识别骨质疏松症风险增加的患者。方法我们对2012年至2017年诊断为AIH的德国211例患者（平均年龄56.8岁；女性79.1％）进行了回顾性横断面研究，并评估了骨矿物质状态。患者通过双能X线骨密度仪进行了骨矿物质密度测量。99名患者的亚组进行了第二次测量。我们使用逻辑回归来确定与骨质疏松症相关的患者和临床因素。我们开发了加权总和评分来估计骨质疏松症的风险，并在发育（n = 141）和验证（n = 70）的患者组中对其进行了测试。结果根据双能X线骨密度仪的测量，有15.6％的患者患有骨质疏松症，占骨质疏松范围的42.9％。50岁或50岁以上的患者中骨质疏松的患病率为19.2％。单因素和logistic回归分析显示，年龄超过54岁，使用糖皮质激素的持续时间> 90个月，体重指数<23 kg / m2和瞬时弹性成像值> 8 kPA，会使骨质疏松症的风险增加13.8倍，6.2倍，5.9-倍和3.0倍。基于这些因素，我们建立了一个指数，该指数可识别出骨质疏松症的低，中和高风险患者，其曲线下面积为0.811。在进行第二次骨密度测定的患者中，骨质流失进展的速度从1年后的2.7％至7年后的8.4％不等（平均骨质流失，每年1.2％）。结论年龄超过50岁的AIH患者中几乎有20％患有骨质疏松症。老年人，使用皮质类固醇激素的持续时间，低体重指数和肝纤维化是造成骨质流失的独立危险因素。