High C-reactive Protein-to-albumin Ratio Levels Are Associated with Osteoporosis in Patients with Primary Biliary Cholangitis

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2024 Jun 14

PMID 38872964

Authors

Yanyan Li

Bo Liu

Xin Li

Affiliations

Soon will be listed here.

Abstract

Objective: Inflammation contributes to the development of metabolic bone diseases. The C-reactive protein-to-albumin ratio (CAR) is an inflammation-based marker with a prognostic value for several metabolic diseases. This study investigated the relationship between the CAR and osteoporosis (OP) in patients with primary biliary cholangitis (PBC).

Methods: Patients with PBC treated at Beijing Ditan Hospital between January 2018 and June 2023 were enrolled. Logistic regression analysis was performed to investigate the factors influencing OP. The predictive value of CAR for OP was evaluated using receiver operating characteristic (ROC) curves. Moreover, a restricted cubic spline (RCS) fitted with a logistic regression model was used to analyze the relationship between CAR and OP.

Results: The prevalence of OP among the patients with PBC was 26.9% (n = 82). CAR levels were higher in the OP group than in the non-OP group (0.33 (0.09, 0.61) vs. 0.08 (0.04, 0.18), P < 0.001). Logistic regression analysis showed that CAR was an independent predictor of OP in patients with PBC (odds ratio = 2.642, 95% confidence interval = 1.537-4.540, P < 0.001). CAR exhibited a good predictive ability for OP, with an areas under the curve (AUC) of 0.741. We found that individuals with CAR values > 0.1 have higher odds of OP. In addition, high CAR levels were associated with an increased prevalence of fragility fractures and high 10-year fracture risk.

Conclusion: High CAR levels were associated with greater odds of developing OP, and the CAR could serve as an independent predictor of OP in patients with PBC.

Citing Articles

The effect of hypersensitive C-reactive protein to albumin ratio on the risk of fragility fracture in the Chinese male population.

Guo L, Zhang N, Fan X, Hou X, Li M, Xu W Osteoporos Int. 2025; .

PMID: 39982456 DOI: 10.1007/s00198-025-07428-x.

References

Liao C, Yu Y, Lin Y, Hsu Y, Chern Y, Chiang J . Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol. 2021; 19(1):139. PMC: 8088626. DOI: 10.1186/s12957-021-02253-y. View

Soeters P, Wolfe R, Shenkin A . Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2018; 43(2):181-193. PMC: 7379941. DOI: 10.1002/jpen.1451. View

Wu Z, He J, Wei R, Liu B, Lin X, Guan J . C-reactive protein and risk of fracture: a systematic review and dose-response meta-analysis of prospective cohort studies. Osteoporos Int. 2014; 26(1):49-57. DOI: 10.1007/s00198-014-2826-y. View

Lima C, Lyra A, Rocha R, Santana G . Risk factors for osteoporosis in inflammatory bowel disease patients. World J Gastrointest Pathophysiol. 2015; 6(4):210-8. PMC: 4644885. DOI: 10.4291/wjgp.v6.i4.210. View

Guanabens N, Cerda D, Monegal A, Pons F, Caballeria L, Peris P . Low bone mass and severity of cholestasis affect fracture risk in patients with primary biliary cirrhosis. Gastroenterology. 2010; 138(7):2348-56. DOI: 10.1053/j.gastro.2010.02.016. View

Xie R, Liu M . Relationship Between Non-Alcoholic Fatty Liver Disease and Degree of Hepatic Steatosis and Bone Mineral Density. Front Endocrinol (Lausanne). 2022; 13:857110. PMC: 8964007. DOI: 10.3389/fendo.2022.857110. View

Schonau J, Wester A, Schattenberg J, Hagstrom H . Risk of fractures and postfracture mortality in 3980 people with primary biliary cholangitis: A population-based cohort study. J Intern Med. 2023; 294(2):164-177. DOI: 10.1111/joim.13624. View

Yang W, Zhang W, Ying H, Xu Y, Zhang J, Min Q . Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio. Int Immunopharmacol. 2018; 62:293-298. DOI: 10.1016/j.intimp.2018.07.007. View

Streiner D, Cairney J . What's under the ROC? An introduction to receiver operating characteristics curves. Can J Psychiatry. 2007; 52(2):121-8. DOI: 10.1177/070674370705200210. View

10.

Handzlik-Orlik G, Holecki M, Wilczynski K, Dulawa J . Osteoporosis in liver disease: pathogenesis and management. Ther Adv Endocrinol Metab. 2016; 7(3):128-35. PMC: 4892399. DOI: 10.1177/2042018816641351. View

11.

Liu Z, Zhang R, Zhou W, Ma R, Han L, Zhao Z . High levels of C-reactive protein-to-albumin ratio (CAR) are associated with a poor prognosis in patients with severe fever with thrombocytopenia syndrome in early stage. J Med Virol. 2022; 94(11):5375-5384. PMC: 9540880. DOI: 10.1002/jmv.27972. View

12.

Rachner T, Khosla S, Hofbauer L . Osteoporosis: now and the future. Lancet. 2011; 377(9773):1276-87. PMC: 3555696. DOI: 10.1016/S0140-6736(10)62349-5. View

13.

Pinto C, Giordano D, Maroni L, Marzioni M . Role of inflammation and proinflammatory cytokines in cholangiocyte pathophysiology. Biochim Biophys Acta Mol Basis Dis. 2017; 1864(4 Pt B):1270-1278. DOI: 10.1016/j.bbadis.2017.07.024. View

14.

Yang X, Yang X, Yang J, Wen X, Wu S, Cui L . High levels of high-sensitivity C reactive protein to albumin ratio can increase the risk of cardiovascular disease. J Epidemiol Community Health. 2023; 77(11):721-727. PMC: 10579461. DOI: 10.1136/jech-2023-220760. View

15.

Gulamhusein A, Hirschfield G . Primary biliary cholangitis: pathogenesis and therapeutic opportunities. Nat Rev Gastroenterol Hepatol. 2019; 17(2):93-110. DOI: 10.1038/s41575-019-0226-7. View

16.

Danford C, Trivedi H, Papamichael K, Tapper E, Bonder A . Osteoporosis in primary biliary cholangitis. World J Gastroenterol. 2018; 24(31):3513-3520. PMC: 6102495. DOI: 10.3748/wjg.v24.i31.3513. View

17.

Carey E, Ali A, Lindor K . Primary biliary cirrhosis. Lancet. 2015; 386(10003):1565-75. DOI: 10.1016/S0140-6736(15)00154-3. View

18.

DErasmo E, Pisani D, Ragno A, Raejntroph N, Letizia C, Acca M . Relationship between serum albumin and bone mineral density in postmenopausal women and in patients with hypoalbuminemia. Horm Metab Res. 1999; 31(6):385-8. DOI: 10.1055/s-2007-978760. View

19.

Collier J, Ninkovic M, Compston J . Guidelines on the management of osteoporosis associated with chronic liver disease. Gut. 2002; 50 Suppl 1:i1-9. PMC: 1867644. DOI: 10.1136/gut.50.suppl_1.i1. View

20.

Kaji H, Yamauchi M, Yamaguchi T, Shigematsu T, Sugimoto T . Mild renal dysfunction is a risk factor for a decrease in bone mineral density and vertebral fractures in Japanese postmenopausal women. J Clin Endocrinol Metab. 2010; 95(10):4635-42. DOI: 10.1210/jc.2010-0099. View