Site-specific alterations of bone matrix mineralization, micro-hardness, and density of mineralized osteocyte lacunae in men with alcohol-associated liver disease: implications for vertebral fracture predilection

Low bone quality has been reported as a source of bone fragility in individuals with alcohol-associated liver disease (AALD). Alterations of the bone matrix, including the spatial BMD distribution and osteocyte lacunar network characteristics, have not been comprehensively assessed in common fracture sites of individuals with AALD. Considering the clinical relevance of vertebral and femoral fragility fractures among these individuals, this cross-sectional study aimed to analyze site-specific BMD distribution, bone mechanical properties, osteocyte lacunar network, and Haversian system characteristics in the first lumbar vertebra and superolateral femoral neck of adult male donors with AALD. Quantitative backscattered electron imaging and Vickers micro-indentation testing were conducted to analyze bone quality in specimens from vertebral and femoral bone harvested at autopsy from adult male donors (n = 24), divided into 2 groups: AALD group (12 individuals with histopathological confirmation of AALD, age: 60 ± 12 yr) and age-matched controls (12 individuals without histopathological features of liver disease, age: 59 ± 12 yr). The comparative assessment revealed significantly lower mean calcium content, reduced Vickers micro-hardness, higher density of osteocyte lacunae occluded with mineralized matter (ie, micropetrosis), thicker osteonal wall, and a higher percentage of osteon refilling in lumbar vertebrae and superolateral femoral neck obtained from the AALD group (p < .05). Although bone quality alterations were congruent in both skeletal sites, the most severe AALD-induced impairment was noted in the trabecular compartment of lumbar vertebrae (p < .05). Our findings revealed a site-specific reduction in trabecular bone mineralization and an increased proportion of mineralized osteocyte lacunae in male individuals with AALD, which may contribute to increased vertebral predilection in these individuals.