Bone mineral density and disorders of mineral metabolism in chronic liver disease

Abstract

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...

Disturbances of parathyroid hormone–vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study

“…Previous studies have shown inconsistent results about the correlation between serum vitamin D level and the severity of liver dysfunction. Our results are in line [3,19] with some studies, and in contradiction to some other studies [16,20]. Our study also showed a significant correlation between low serum vitamin D level and markers of liver function insufficiency including coagulopathy, hypoalbuminemia, hyperbilirubinemia, and thrombocytopenia, in agreement with other studies [21][22][23].…”

“…Although in advanced stages of CLD, from any cause, bone mass loss is frequently (20-60%) evident [3,4], the clinical relevance of vitamin D-parathyroid hormone (PTH) disturbances in hepatic osteodystrophy is still unclear. The intestinal absorption of cholecalciferol (vitamin D3) and 25-hydroxycholecalciferol is affected only in the presence of severe cholestasis.…”

Czynność osi GH/IGF-I, stężenie hormonów kalciotropowych we krwi oraz gęstość mineralna kości u młodych osób z przewlekłym wirusowym zapaleniem wątroby

“…Our results comply with those of previous reports [30][31][32][33][34][35], but the loss of bone mass among our subjects was significantly lower than has been found by some other authors. We believe that this is due to the decreased severity of hepatic impairment presented by our patients.…”

The Clinical Importance of Biochemical Bone Markers in Patients With Alcoholic and Viral Liver Cirrhosis / Klinički Značaj Biohemijskih Koštanih Markera Kod Pacijenata Sa Alkoholnom I Virusnom Cirozom Jetre

“…A similar opinion was presented by Javad et al (12) who reported that, in patients with viral B or C cirrhosis, osteopenia and osteoporosis were recorded in 42% and 26% of patients, respectively. High frequency of reduced bone density was reported by George et al (13) who described 72 patients with alcoholic and viral cirrhosis out of whom 68% had lower bone mineral density.…”

“…George et al (13) while analyzing a group of 72 patients with viral liver cirrhosis confirmed lower osteocalcin values in 68% of subjects and increased free deoxypyridinoline in 79% of patients. Sub sequently, Goral et al (10) reported that lower values of osteocalcin as a marker of bone formation were found in patients with virus B and C liver cirrhosis.…”