When people think of liver disease, jaundice or alcohol abuse may come to mind. However, common musculoskeletal disorders are also present in chronic liver disease (CLD) patients. Hips, shoulders, and knees are the most commonly affected joints. Many factors increase the likelihood that patients with CLD will experience musculoskeletal disorders.
Risk Factors
Alcohol and Steroid Abuse
These are commonly associated with CLD and are the main factors leading to negative orthopedic outcomes not caused by trauma.
Medications
Certain prescriptions such as diuretics can ultimately lead to bone loss. There are also adverse effects from advanced liver disease drugs, such as terlipressin.
Surgery
Patients with CLD have an increased risk for osteoporosis and bone fractures. Undergoing any orthopedic surgery (such as a hip replacement) as a result of liver disease-related fractures is associated with longer hospital stays, higher costs, greater readmission rates, and increased death.
These risks can be minimized through early diagnosis of liver disease. Prevention and treatment strategies include lifestyle and dietary changes, avoiding alcohol, and calcium and Vitamin D intake.
Complications
Infections and impaired immunity are commonly associated with CLD. In general, CLD patients are more prone to bone infections, primarily of the spine, as a result of compromised immunity and often present with bone pain and swelling. Among these infectious diseases are prosthetic joint infections. Skin edema in the legs (which can lead to infections such as cellulitis) is commonly found in patients with CLD.
Septic Arthritis is an infection found in patients with CLD, with symptoms such as fever, joint pain, swelling, and impaired range of motion. Preventing irreversible joint damage both through early diagnosis and treatment plans is critical.
Necrotizing fasciitis (NF) is a painful soft tissue bacterial infection that causes ulcers and blisters. Liver cirrhosis is a common underlying risk factor for NF, which carries a poor prognosis, despite current advanced treatments. NF is usually a surgical emergency.
Sarcopenia (Muscle Wasting) is an often overlooked result of having CLD. It also has a poor prognosis because it is often linked to falls, fractures, and poor response to stresses, including infections and surgeries. Sarcopenia, a result of malnutrition frequently associated with CLD, affects quality of life and survival. Early identification and appropriate management are essential.
Bone Fractures- studies revealed a strong link between non-alcoholic fatty liver disease and fracture risk. This is especially true if the disease has progressed to cirrhosis. Fracture risk can be minimized by reversing risk factors and through early diagnosis of liver disease. Prevention and treatment strategies include lifestyle and dietary changes, avoiding alcohol, avoiding fructose, and increasing calcium and Vitamin D intake.
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