Osteoporosis, Mineral Metabolism, and Serum Soluble Tumor Necrosis Factor Receptor p55 in Viral Cirrhosis

Abstract

Liver cirrhosis is a risk factor for osteoporosis. Nevertheless, little is known about the mechanisms of bone mass loss in patients with viral cirrhosis. TNFalpha is a potent bone-resorbing agent. Serum concentrations of soluble TNF receptor p55 (sTNFR-55) correlate with clinical activity in liver cirrhosis. Our aim was to evaluate the possible role of sTNFR-55 in the pathogenesis of osteoporosis in patients with viral cirrhosis and its relationship with bone turnover markers. We studied 40 consecutive patients with viral cirrhosis and no history of alcohol intake and 26 healthy volunteers. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). Patients with viral cirrhosis had reduced BMD (expressed as the z-score) in all sites [LS, -1.5 +/- 0.22 (P < 0.001); FN, -0.37 +/- 0.15 (P < 0.01)]. Serum concentrations of sTNFR-55 and urinary deoxypyridinoline, a biochemical marker of bone resorption, were significantly higher in patients with osteoporosis than in patients without osteoporosis (P < 0.001 and P < 0.05, respectively). Serum levels of sTNFR-55 correlated inversely with BMD in LS (r = -0.62; P < 0.005) and FN (r = -0.47; P < 0.05) and positively with urinary deoxypyridinoline (r = 0.72, P < 0.001). Our findings show that high serum concentrations of sTNFR-55 play a role in the pathogenesis of viral cirrhosis-associated bone mass loss and provide evidence of increased bone resorption related to the high serum sTNFR-55 levels.

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

“…However, in spite of the decreased value of vitamin D particularly in advanced cirrhosis patients, the influence of the lower 25-hydroxy vitamin D 3 values on the BMD was not determined in the study of Gonzales-Calvin et al (15). Based on regression analysis, the authors concluded that, in cirrhotic patients, 25-hydroxy vitamin D 3 was not a valid predictor of osteoporosis.…”

“…Some authors reported that PTH was increased in liver insufficiency, while others underscored that PTH values were normal or even reduced in this condition. The prevailing opinion is that the changes in PTH concentrations have no significant effect on the development of osteoporosis in cirrhotic patients (10,14,15). Although vitamin D inadequacy is very common with these patients, secondary hyperparathyroidism is rather rare (16).…”

Vitamin D Serum Levels in Patients With Liver Cirrhosis in Southern Iran

“…Some researchers believe that level of 25 (OH) D decreases with the progression of liver disease (6)(7)(8)(9)(10), but some others did not find any difference between cirrhotic and non-cirrhotic patients (11) or between the Child-Pugh groups (12). Despite the evidence gathered about the role of vitamin D in a number of activities related to liver function, including regulation of secretion of metalloproteinases and their inhibitors, fibroblast proliferation and collagen synthesis (13,14), now evaluation and correction of vitamin D status are not part of the routine treatment of these patients.…”

Valoración de la densidad mineral ósea, marcadores de remodelado óseo, el sistema OPG/RANKL y el sTNF-RI en la enfermedad de Crohn

“…Se ha comprobado que los pacientes con EC presentan niveles elevados del receptor soluble del TNF-␣ tipo I (sTNF-RI) y tipo II (sTNF-RII) en suero, y que sus niveles se correlacionan con la actividad de la enfermedad [25][26][27][28][29] . Los niveles de los receptores solubles del TNF-␣ en suero se correlacionan bien con los de este, presentando la determinación de los receptores solubles la ventaja adicional de que éstos poseen una mayor estabilidad, puesto que el TNF-␣ es rápidamente eliminado de la circulación 27 .…”

“…Los niveles de los receptores solubles del TNF-␣ en suero se correlacionan bien con los de este, presentando la determinación de los receptores solubles la ventaja adicional de que éstos poseen una mayor estabilidad, puesto que el TNF-␣ es rápidamente eliminado de la circulación 27 .…”