Hepatic osteodystrophy

Diamond, Terrence; Stiel, Daniel; Lunzer, Michael; McDowall, D.; Eckstein, Robert P.; Posen, Solomon

doi:10.1016/0016-5085(89)90783-x

Cited by 150 publications

(23 citation statements)

References 46 publications

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“…Results of this study have documented that a significant reduction in BMD was present in 60% of patients with advanced CLD, as demonstrated by DXA scanning, a prevalence rate similar to previous reports [1][2][3]. The 10 patients with cholestatic liver disease had the most severe bone disease, an association that has not been consistently shown by other investigators [7,19]. Females had more severe bone disease than males, presumably related to the concurrence of a postmenopausal state and CLD.…”

Section: Discussionsupporting

confidence: 74%

“…Traditionally, this has been investigated only by dynamic histomorphometry of bone at a cellular level and at a tissue level. Though bone biomarkers cannot measure activity at a cellular level they can estimate activity at a tissue level [2,7,12,14]. In this study we used currently available markers of bone resorption (DPD) and formation (PICP) to calculate the uncoupling index.…”

Section: Discussionmentioning

confidence: 99%

“…Though significant correlations have been documented between serum osteocalcin and the rate of bone formation and between urinary hydroxyproline levels and the rate of bone resorption in patients with CLD [7,10,12,14], few studies provide detailed measurements of biochemical markers of bone turnover in patients with CLD.…”

mentioning

confidence: 98%

“…Osteomalacia, due to concomitant vitamin D deficiency and calcium malabsorption, was traditionally considered to be the major bone disorder in patients with CLD, but is found in only a minority of patients [4][5][6][7]. Studies of bone histomorphometry have shown a reduction in formation rate at the level of the bone multicellular unit [7][8][9][10][11][12][13]; a number of studies have also suggested an increase in resorption [13][14][15]. The most detailed study of bone remodeling at the total tissue level showed an increase in bone turnover with a negative remodeling balance [12].…”

mentioning

confidence: 99%

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Bone Density, Vitamin D Status, and Disordered Bone Remodeling in End-Stage Chronic Liver Disease

Crosbie

Freaney

McKenna

et al. 1999

Calcified Tissue International

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Hepatic osteodystrophy occurs in up to 50% of patients with chronic liver disease (CLD). The aim of this study was to determine the relative contribution of increased resorption and decreased formation to hepatic osteodystrophy by measuring biochemical markers. Twenty-seven patients with advanced CLD (14 female, 13 male) were enrolled. Bone mineral density (BMD), measured at the lumbar spine, and femoral neck, were measured by dual energy X-ray absorptiometry (DXA); bone turnover was assessed using biochemical markers of bone formation and resorption. Based on WHO criteria, osteoporosis and osteopenia were present in 41% and 18% of patients, respectively. All three markers of bone resorption (free deoxypyridinoline, pyridinoline, and hydroxyproline) were increased significantly in patients with CLD. There was a less marked change in the markers of bone formation (osteocalcin, procollagen type 1 peptide, and bone alkaline phosphatase), resulting in a negative uncoupling index in 23/27 (85%) of the patients. Only two (7%) patients had biochemical changes consistent with osteomalacia. The results suggest that increased bone resorption is the predominant cause of hepatic osteodystrophy and therapeutic strategies should be designed to suppress bone resorption, especially in preparation for liver transplantation. Bone biomarkers may be useful alternatives to bone biopsy in evaluating hepatic osteodystrophy.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

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Bone Density, Vitamin D Status, and Disordered Bone Remodeling in End-Stage Chronic Liver Disease

Crosbie

Freaney

McKenna

et al. 1999

Calcified Tissue International

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“…Diamond et al 21 detected osteoporosis in 17 (21%) of 80 patients with chronic liver diseases, based on the results of iliac bone biopsy, but none of the patients had osteomalacia. However, the bone formation rates were significantly reduced in 57% of the patients.…”

Section: Relationships Between Bmd and Upyr And Udpyr In Patients Witmentioning

confidence: 98%

Osteodystrophy in patients with chronic hepatitis and liver cirrhosis

et al. 1996

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Bone mineral density (BMD) of the lumber vertebrae and factors related to bone metabolism were determined in patients with chronic viral hepatitis and patients with liver cirrhosis to clarify correlations between hepatic dysfunction, considered to be one of the causes of hepatic osteodystrophy, and decrease in bone mass. BMD of the second to fourth lumbar vertebrae was determined with a Lunar (Madison, WI, USA) DPX, a dual-energy X-ray absorptiometry diagnostic system. BMD was significantly lowest in patients with liver cirrhosis, followed by patients with chronic hepatitis, and healthy subjects, in this order. There was a significantly positive but weak correlation between albumin and BMD. Levels of 25(OH)D and 1,25(OH)2D were significantly lower in patients with liver cirrhosis than in those with chronic hepatitis. BMD and vitamin D were decreased in all patients whose cholinesterase (ChE) was below 0.3 delta pH. Urinary pyridinoline (Upyr) was significantly higher in the patients with liver cirrhosis, in whom bone mass was decreased, than in the patients with chronic hepatitis, whereas serum osteocalcin levels were distributed in the upper normal range in patients with chronic hepatitis and those with liver cirrhosis. There was a positive correlation between 25(OH)D and serum osteocalcin levels in patients with liver cirrhosis. These results indicate that osteogenesis is decreased and suggest that the decrease in BMD which occurs in viral liver cirrhosis, probably related to decreased, bone formation and slight promotion of bone resorption, reflects deranged hepatic function. This is the first report of Upyr and urinary deoxypyridinoline (UDpyr) determination in patients with liver cirrhosis and patients with chronic hepatitis. The negative correlation of Upyr and UDpyr with ChE is a novel finding.

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