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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Associations of Myosteatosis with Osteoporosis, Vertebral Fractures, and Long-Term Prognosis in Patients with Cirrhosis

  • Sachie Kiryu1,2
  • Chisato Saeki1,2
  • Mitsuru Saito3
  • Tomoya Kanai1,2
  • Naoto Nishimura1,2
  • Koichi Oishi1,2
  • Tomone Sarukawa1,2
  • Takahiko Toyonaga1
  • Masanori Nakano1,2
  • Yuichi Torisu1,2
  • Masayuki Saruta1
  • Akihito Tsubota4
4 affiliations
  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku 105-8461, Tokyo, Japan
  2. 2Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, 50 Takashima-cho, Fuji-shi 417-8567, Shizuoka, Japan
  3. 3Department of Orthopedic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku 105-8461, Tokyo, Japan
  4. 4Project Research Units, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku 105-8461, Tokyo, Japan
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Abstract

Background: Myosteatosis is increasingly recognized as a clinically relevant skeletal muscle abnormality associated with adverse clinical outcomes. This study aimed to investigate the associations of myosteatosis with osteoporosis, vertebral fractures, and prognosis in patients with cirrhosis. Methods: This retrospective study included 139 patients with cirrhosis. Skeletal muscle radiodensity was calculated as the mean Hounsfield unit (HU) at the L3 level on computed tomography. Myosteatosis was defined as <33 HU for men and <28 HU for women, using previously reported sex-specific cutoffs derived from a cohort of patients with cirrhosis. Sarcopenia and osteoporosis were diagnosed according to the Japanese Society of Hepatology and World Health Organization criteria, respectively. Vertebral fractures were assessed using lateral thoracolumbar radiographs. Results: The prevalences of myosteatosis, osteoporosis, vertebral fractures, and sarcopenia were 62.6%, 32.4%, 30.9%, and 36.0%, respectively. During a median follow-up of 67.1 months, 37 liver-related deaths (26.6%) occurred. The prevalence of myosteatosis was significantly higher in patients with osteoporosis (p = 0.003), vertebral fractures (p = 0.021), and sarcopenia (p < 0.001) than in those without the respective conditions. The coexistence of myosteatosis and sarcopenia was associated with a higher prevalence of osteoporosis and vertebral fractures than either condition alone or neither condition (p < 0.001 for both). Osteoporosis remained independently associated with myosteatosis after multivariable adjustment (adjusted odds ratio = 3.04; p = 0.039). Liver-related mortality-free survival was significantly lower in the myosteatosis group than in the non-myosteatosis group (p = 0.007). Furthermore, myosteatosis was independently associated with liver-related mortality (adjusted hazard ratio = 2.78; p = 0.026). Conclusions: Myosteatosis is associated with bone diseases and poorer survival, highlighting the importance of comprehensive musculoskeletal assessment in patients with myosteatosis.

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Cite

BibTeXRIS
BibTeX
@article{kiryu2026associations,
  title = {{Associations of Myosteatosis with Osteoporosis, Vertebral Fractures, and Long-Term Prognosis in Patients with Cirrhosis}},
  author = {Sachie Kiryu and Chisato Saeki and Mitsuru Saito and Tomoya Kanai and Naoto Nishimura and Koichi Oishi and Tomone Sarukawa and Takahiko Toyonaga and Masanori Nakano and Yuichi Torisu and Masayuki Saruta and Akihito Tsubota},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218438},
  url = {https://www.mdpi.com/2077-0383/15/21/8438},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Associations of Myosteatosis with Osteoporosis, Vertebral Fractures, and Long-Term Prognosis in Patients with Cirrhosis
AU  - Sachie Kiryu
AU  - Chisato Saeki
AU  - Mitsuru Saito
AU  - Tomoya Kanai
AU  - Naoto Nishimura
AU  - Koichi Oishi
AU  - Tomone Sarukawa
AU  - Takahiko Toyonaga
AU  - Masanori Nakano
AU  - Yuichi Torisu
AU  - Masayuki Saruta
AU  - Akihito Tsubota
PY  - 2026
DA  - 2026/10/29
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218438
UR  - https://www.mdpi.com/2077-0383/15/21/8438
AB  - Background: Myosteatosis is increasingly recognized as a clinically relevant skeletal muscle abnormality associated with adverse clinical outcomes. This study aimed to investigate the associations of myosteatosis with osteoporosis, vertebral fractures, and prognosis in patients with cirrhosis. Methods: This retrospective study included 139 patients with cirrhosis. Skeletal muscle radiodensity was calculated as the mean Hounsfield unit (HU) at the L3 level on computed tomography. Myosteatosis was defined as <33 HU for men and <28 HU for women, using previously reported sex-specific cutoffs derived from a cohort of patients with cirrhosis. Sarcopenia and osteoporosis were diagnosed according to the Japanese Society of Hepatology and World Health Organization criteria, respectively. Vertebral fractures were assessed using lateral thoracolumbar radiographs. Results: The prevalences of myosteatosis, osteoporosis, vertebral fractures, and sarcopenia were 62.6%, 32.4%, 30.9%, and 36.0%, respectively. During a median follow-up of 67.1 months, 37 liver-related deaths (26.6%) occurred. The prevalence of myosteatosis was significantly higher in patients with osteoporosis (p = 0.003), vertebral fractures (p = 0.021), and sarcopenia (p < 0.001) than in those without the respective conditions. The coexistence of myosteatosis and sarcopenia was associated with a higher prevalence of osteoporosis and vertebral fractures than either condition alone or neither condition (p < 0.001 for both). Osteoporosis remained independently associated with myosteatosis after multivariable adjustment (adjusted odds ratio = 3.04; p = 0.039). Liver-related mortality-free survival was significantly lower in the myosteatosis group than in the non-myosteatosis group (p = 0.007). Furthermore, myosteatosis was independently associated with liver-related mortality (adjusted hazard ratio = 2.78; p = 0.026). Conclusions: Myosteatosis is associated with bone diseases and poorer survival, highlighting the importance of comprehensive musculoskeletal assessment in patients with myosteatosis.
SN  - 2077-0383
ER  -