Osteomalacia, vitamin D deficiency and cholestasis in chronic liver disease.
Twenty-nine patients with chronic liver disease, nine of whom had symptoms suggesting bone disease, were studied by bone histology. Nine had osteomalacia; six associated with cholestatic liver disease and three with primarily hepatocellular disease. Two of these had clinical and biochemical features of cholestasis for at least a year and the other had alcoholic cirrhosis associated with severe malnutrition. Excluding the latter patient, histological osteomalacia was significantly associated with presence and duration of cholestasis. Plasma 25-hydroxyvitamin D was low and fasting urine hydroxyproline/creatinine ratio was high in all patients with osteomalacia but were abnormal also in some patients who did not have histological osteomalacia. Serum calcium, phosphate, alkaline phosphatase, vitamin D-binding protein and radiology were unhelpful in many patients with osteomalacia. Vitamin D-deficiency correlated significantly with deficiency of other fat-soluble vitamins and those patients with rachitic levels of plasma 25-hydroxyvitamin D showed no seasonal variation, suggesting a combination of malabsorption of vitamin D and reduced sunlight exposure. We suggest that patients with chronic liver disease with cholestasis for at least a year are at risk from osteomalacia and that those likely to have this complication may be identified by plasma 25-hydroxyvitamin D and/or fasting urine hydroxyproline/creatinine ratio measurements. The diagnosis can only be made with certainty by bone biopsy.
D015652:25-Hydroxyvitamin D 2; D000293:Adolescent; D000328:Adult; D000368:Aged; D002779:Cholestasis / Q000150:complications*; D002908:Chronic Disease; D004872:Ergocalciferols / Q000031:analogs & derivatives / Q000097:blood; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008875:Middle Aged; D010018:Osteomalacia / Q000209:etiology* / Q000378:metabolism; D012306:Risk; D012621:Seasons; D014808:Vitamin D Deficiency / Q000150:complications* / Q000209:etiology
D004872:Ergocalciferols; D015652:25-Hydroxyvitamin D 2