Clinical Indicators of Bone Deterioration in Alcoholic Liver Cirrhosis and Chronic Alcohol Abuse: Looking beyond Bone Fracture Occurrence.

Although previous studies indicated that chronic alcohol abuse (CAA) and alcoholic liver cirrhosis (ALC) are associated with increased bone fragility, understanding bone fragility determinants is still modest in these individuals. We used a comprehensive individualized clinical fracture risk assessment approach (vertebral osteodensitometry, femoral osteodensitometry and geometry, and serum bone turnover biomarkers) to compare adult male patients with ALC who have not previously had femoral or vertebral fractures (n = 39), patients with CAA (without liver cirrhosis, n = 78) who have not previously had femoral or vertebral fractures and healthy age- and sex-matched controls (n = 43). Our data suggested that intertrochanteric bone mineral density was significantly lower in ALC and CAA patients than in controls. Also, the trabecular bone score was considerably lower in ALC patients compared with CAA and control individuals. The most significant inter-group differences in femoral geometry were noted on the femoral shaft. Patients with ALC and CAA have a higher 10-year risk of major osteoporotic fractures compared to the controls. Analysis of bone turnover biomarkers showed increased osteoprotegerin and beta-C-terminal telopeptide serum concentrations and decreased insulin growth factor-1 concentrations in patients with ALC compared to CAA and control groups. Our data revealed that bone alterations are present in patients with ALC and CAA even if they did not sustain a nontraumatic bone fracture, but it is also indicative that current bone-assessing clinical methods are not entirely reliable. Thus, future studies should focus on developing a reliable integrative clinical tool that can be used to accurately predict and prevent bone fracture occurrences in patients with ALC and CAA.

The Association Between Family Violence, Depression and Anxiety Among Women Whose Partners Have Been Treated for Alcohol Dependence.

The negative effects of men's excessive alcohol consumption on family members are well known. However, less is known about how men's alcohol dependence is associated with the mental health of their female spouses residing with them. Therefore, the aim of this study was to investigate the prevalence and factors associated with depression, anxiety, and intimate partner violence against women (IPVAW) whose male spouses are undergoing treatment for alcohol dependence. We hypothesize that men with alcohol dependency, who are also violent, present a serious threat to women's mental health. We conducted a cross-sectional study among 104 women whose male partners had been admitted for inpatient treatment for alcohol dependence. Women's depression was measured by the Beck Depression Inventory (BDI-II); anxiety was measured by the Beck Anxiety Inventory (BAI), and exposure to physical and sexual IPVAW was measured by the Conflict Tactics Scale (CTS-2). Multinomial logistic regression analyses were conducted in order to analyze factors associated with depression and anxiety. The prevalence of moderate/severe depression and anxiety among the women was 34.6% and 25.2%, respectively, while almost half (48.1%) experienced IPV during the past 12 months. After adjustments for age, exposure to IPV increased the chances of experiencing moderate/severe depression by 37.5 times (95% CI 7.91-177.76), and 8.15 times for moderate/severe anxiety (95% CI 2.45-27.14). The mental health of women whose partners have alcohol dependence is significantly threatened and should be considered, especially when it is associated with exposure to spousal violence.

The Clinical Importance of Cystatin C and Hepatic Artery Resistive Index in Liver Cirrhosis.

BACKGROUND: Data suggest cystatin C (CysC) levels and hepatic artery resistive index (HARI) correspond to the progression of chronic liver disease. We aimed to evaluate the clinical significance of these parameters in assessment of fibrosis in patients with liver cirrhosis. METHODS: The cross-sectional study included 63 patients with liver cirrhosis. A control group consisted of 30 age- and gender-matched healthy persons. RESULTS: We confirmed significantly higher values of CysC in patients with cirrhosis compared to control group (p = 0.036). Average value of HARI in the examined group was increased (0.72 ± 0.06) and there was the statistically significant difference compared to controls (0.66 ± 0.03) (p < 0.001). We found statistically significant correlation between HARI and CysC in the study group. Analyzing the possibility of distinguishing healthy subjects from patients with fibrosis, we have found that the area under the curve is far greater in the HARI index than CysC. Comparison of CysC among Child⁻Pugh stages and correlation with a model for end-stage liver disease (MELD) score showed statistically significant results. CONCLUSION: We confirmed HARI is a more accurate parameter than CysC in discriminating healthy subjects from patients with fibrosis, while CysC could be a better indicator of the stage of liver cirrhosis.