Osteosarcopenia, Osteoporosis, and Sarcopenia in Liver Cirrhosis: Prevalence, Predictors, and Prognostic Significance of IGF-1 Deficiency

Background/Objectives: Sarcopenia (SP) and osteoporosis (OP) are common yet underrecognized complications of liver cirrhosis, contributing to increased morbidity and mortality. Their coexistence, termed osteosarcopenia (OS), represents a compounded musculoskeletal impairment. Insulin-like growth factor 1 (IGF-1), synthesized in the liver, has been implicated in muscle and bone metabolism. This study aimed to assess the prevalence and association of laboratory and clinical parameters with SP, OP, and OS in cirrhotic patients, with a focus on IGF-1 deficiency and their impact on mortality. Methods: This cross-sectional study included 100 cirrhotic patients at a tertiary center. Sarcopenia was diagnosed using CT-derived L3 skeletal muscle index and osteoporosis via the DEXA scan. IGF-1 levels and metabolic parameters were measured. Multivariate logistic regression identified laboratory and clinical factors associated with musculoskeletal complications. However, due to the cross-sectional design, causal relationships could not be inferred. Results: SP, OP, and OS were present in 41%, 22%, and 11% of patients, respectively. IGF-1 levels were significantly lower in patients with SP, OP, and OS (p < 0.05) and were independently associated with increased risk of SP (OR = 1.797, p = 0.006), OP (OR = 1.873, p = 0.045), and OS (OR = 2.326, p = 0.003). Mortality rates were significantly higher among patients with OS (72.7%), OP (77.3%), and SP (56.1%). OS conferred the highest adjusted mortality risk (OR = 2.739, p = 0.009), followed by SP (OR = 2.278, p = 0.015) and OP (OR = 1.958, p = 0.036). Conclusions: Musculoskeletal complications are highly prevalent and predictive of mortality in cirrhosis. IGF-1 deficiency is a strong independent biomarker for SP, OP, and OS. Routine screening and early intervention targeting IGF-1 pathways and nutrition may improve outcomes in this population.