Skip to main content

Advertisement

Log in

Hepatic Osteodystrophy Is Common in Patients with Noncholestatic Liver Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Patients with cirrhosis are more prone to develop metabolic bone disease. Scanty literature data are available on osteodystrophy in patients from India with noncholestatic liver diseases.

Methods

Patients diagnosed with cirrhosis were prospectively evaluated for bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine, and left forearm (distal radius). Correlation of BMD with age, sex, etiology of cirrhosis, Child’s class, serum bilirubin, alkaline phosphatase (ALP), albumin, calcium, phosphate, 25-hydroxyvitamin D (25(OH)D), and parathyroid hormone (PTH) was studied.

Results

The study group comprised 115 cirrhotic patients (107 males and 8 females). Etiology of cirrhosis was alcohol in 67 (58.2%) and viral in 48 (41.7%). Hepatitis B was diagnosed in 29 (25.2%) and hepatitis C in 19 (16.5%). Mean age was 49 (± 5.5) years. Prevalence of osteodystrophy was significantly higher in males than in females; 97.1% and 75% respectively (P = .038). Both alcoholic and viral groups had similar baseline characteristics except albumin levels. Child’s class was B in 72 patients and C in 43. Low BMD was present in 97% of patients with alcoholic cirrhosis and 93.7% with viral cirrhosis (P > .05). Low BMD was present at the femoral neck in 80.8% of patients, lumbar spine in 77.3%, and forearm in 59.9%. PTH correlated negatively with BMD.

Conclusion

Osteodystrophy is common in alcoholic and viral cirrhosis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rouillard S, Lane NE. Hepatic osteodystrophy. Hepatology. 2001;33:301–307.

    Article  PubMed  CAS  Google Scholar 

  2. Hay JE, Guichelaar MM. Evaluation and management of osteoporosis in liver disease. Clin Liver Dis. 2005;9:747–766.

    Article  PubMed  Google Scholar 

  3. Carey EJ, Balan V, Kremers WK, Hay JE. Osteopenia and osteoporosis in patients with end-stage liver disease caused by hepatitis C and alcoholic liver disease: not just a cholestatic problem. Liver Transpl. 2003;9:1166–1173.

    Article  PubMed  Google Scholar 

  4. George J, Ganesh HK, Acharya S, et al. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol. 2009;15:3516–3522.

    Article  PubMed  CAS  Google Scholar 

  5. Heaney RP. The bone-remodeling transient: implications for the interpretation of clinical studies of bone mass change. J Bone Miner Res. 1994;9:1515–1523.

    Article  PubMed  CAS  Google Scholar 

  6. Lips P. Vitamin D physiology. Prog Biophys Mol Biol. 2006;92:4–8.

    Article  PubMed  CAS  Google Scholar 

  7. Goswami R, Gupta N, Goswam D, et al. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr. 2000;72:472–475.

    PubMed  CAS  Google Scholar 

  8. Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. 2005;115:3318–3325.

    Article  PubMed  CAS  Google Scholar 

  9. McDonald AJ, Dunstan CR, Dilworthi P, et al. Bone loss after liver transplantation. Hepatology. 1991;14:613–619.

    Article  PubMed  CAS  Google Scholar 

  10. Tuna H, Birtane M, Ekuklu G, Cermik F, Tuna F, Kokino S. Does quantitative tibial ultrasound predict low bone mineral density defined by dual energy X-ray absorptiometry? Yonsei Med J. 2008;49:436–442.

    Article  PubMed  Google Scholar 

  11. Murray KF, Carithers RL Jr, AASLD. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2005;41:1407–1432.

    Article  PubMed  Google Scholar 

  12. Leslie WD, Bernstein CN, Leboff MS, American Gastroenterological Association Clinical Practice Committee. AGA technical review on osteoporosis in hepatic disorders. Gastroenterology. 2003;125:941–966.

    Article  PubMed  Google Scholar 

  13. Salama ZAL, Lofty AN, Azizy HME, Attia MAN. Evaluation of hepatic osteodystrophy in patients with liver cirrhosis and correlation with severity of liver disease. Arab J Gastroenterol. 2007;8:10–14.

    Google Scholar 

  14. Cijevevschi C, Mihai C, Zbranca E, Gogalniceanu P. Osteoporosis in liver cirrhosis. Rom J Gastroenterol. 2005;14:337–341.

    Google Scholar 

  15. Figueiredo FAF, Brandao C, Perez RM, Barbosa WF, Kondo M. Low bone mineral density in noncholestatic liver cirrhosis: prevalence, severity and prediction. Arq Gastroenterol. 2003;40:152–158.

    Article  PubMed  Google Scholar 

  16. Duarte MP, Farias ML, Coelho HS, et al. Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. J Gastroenterol Hepatol. 2001;16:1022–1027.

    Article  PubMed  CAS  Google Scholar 

  17. Karan MA, Erten N, Tascioglu C, Karan A, Sindel D, Dilsen G. Osteodystrophy in posthepatitic cirrhosis. Yonsei Med J. 2001;42:547–552.

    PubMed  CAS  Google Scholar 

  18. Gallego-Rojo FJ, Gonzalez-Calvin JL, Muñoz-Torres M, Mundi JL, Fernandez-Perez R, Rodrigo-Moreno D. Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis. Hepatology. 1998;28:695–699.

    Article  PubMed  CAS  Google Scholar 

  19. Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol. 1996;11:417–421.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Y. K. Chawla.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Choudhary, N.S., Tomar, M., Chawla, Y.K. et al. Hepatic Osteodystrophy Is Common in Patients with Noncholestatic Liver Disease. Dig Dis Sci 56, 3323–3327 (2011). https://doi.org/10.1007/s10620-011-1722-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1722-y

Keywords

Navigation