Evaluation of Osteoporosis in Patients with Non-alcoholic Liver Cirrhosis

Abstract

Background :

The liver is a vital organ that plays an important role in the metabolism of nutritional agents, drugs and hormones,synthesis of various proteins, coagulation factors and maintenance of hemostasis between calcium,and phosphorous. Biochemical changes in the skeletal system such as osteopenia and pathologic fractures may follow hepatic failure. This researchevaluates metabolic bone changes in non-alcoholic cirrhotic patients.

Materials and Methods:

We evaluated 50 known cases of nonalcoholic cirrhosis in the Internal Medicine Clinic and Ward of GhaemHospital during the second half of 2004. Inclusion criteria were: age >14 years anda Child-Pugh score of A or B. Exclusion criteria were: history of previous bone metabolic disorders; endocrine disease; hepatocellular carcinoma; liver metastasis;previous use of calcium, vitamin D, calcitonin, bisphosphonates, hormone replacement therapy, and prednisolone; and alcoholics. Patients underwent clinical and laboratory studies in addition to bone densitometry analyses of the femoral neck and second to fourth lumbar spine area.

Results:

Patients' mean age was 48.18±15.49 years and the male to female ratio was 1.6 to 1. Cases presented with the following types of non-alcoholic cirrhosis: post-hepatitis B (58%), cryptogenic (26%), autoimmune hepatitis (10%), post-hepatitis C (4%) and primary biliary cirrhosis (2%). There were 68% of our cases classified as Child-Pugh score A; 32% were Child-Pugh score B. Osteoporosis and osteopenia were more common in the Child-Pugh B group. T-score of the femoral neck was normal in 39 (78%) cases. The lumbar spine Z-score was normal in 46 (92%) and the femoral neck Z-score was normal in 48 (98%) cases. There were more post-hepatitis B and cryptogenic cirrhosis cases that had decreased bone density.The Child-Pugh A group had more increased calcium, phosphorous, and PTH levels and decreased ALP levels compared to the Child-Pugh B group.

Conclusion:

Progression of liver failure (according to Child-Pugh) in patients with non-alcoholic cirrhosis to some extent causes increased osteoporosis and osteopenia. It is necessary to place increased emphasis on the importance of mineral supplementation in cirrhotic patients.