AIM:To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis.
METHODS:The study was performed on 72 Indian patients with cirrhosis (63 male, 9 female; aged < 50 years). Etiology of cirrhosis was alcoholism (n = 37), hepatitis B (n = 25) and hepatitis C (n = 10). Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density (BMD) was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2.
RESULTS:Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium: protein ratio and calcium: phosphorus ratio. Vitamin D deficiency was highly prevalent (92%). There was a high incidence of hypogonadism (41%). Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor (IGF) 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low (68%) and urinary deoxypyridinoline to creatinine ratio was high (79%), which demonstrated low bone formation with high resorption.
INTRODUCTIONMetabolic bone disease is a common complication of long-standing liver disease, ranging from cholestatic disorders to alcoholic, autoimmune and post-viral cirrhosis [1] . Often known as hepatic osteodystrophy (HO),
Bone mineral density and disorders of mineral metabolism in chronic liver diseaseJoe George, Hosahithlu K Ganesh, Shrikrishna Acharya, Tushar R Bandgar, Vyankatesh Shivane, Anjana Karvat, Shobna J Bhatia, Samir Shah, Padmavathy S Menon, Nalini Shah
BRIEF ARTICLESwww.wjgnet.com it is well-recognized among individuals with chronic liver disease (CLD). Its etiology is poorly understood and is thought to vary according to the type, severity and progression of the liver disease, along with a multitude of other contributing factors including the ethnicity of the population studied. It can result in spontaneous low-trauma fractures that significantly impact on the morbidity, quality of life, and even survival, through pain, deformity and immobility. With liver transplantation steadily taking the center stage in treatment of end-stage cirrhosis of varying etiology and offering long-term survival, bone disease has snowballed into one of the major determinants of survival and quality of life in this cohort [1] . Keeping in view the numerous therapeutic options for bone disease [2] already available and those under development, it is prudent to characterize this condition in order to give these patients a better chance of survival. The medical...
