title: Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease.
abstract: BACKGROUND
  The main process involved in hepatic osteodystrophy seems to be osteoporosis, but decreased 25-hydroxylation of vitamin D might lead to osteomalacia and secondary hyperparathyroidism.
  
  
  RESULTS
  We studied bone mineral density (BMD) by using DEXA-Expert Lunar, biochemical markers of bone turnover and calcium-parathyroid hormone (PTH)-vitamin D axis in 100 patients with chronic viral hepatitis secondary to hepatitis C virus: 49 non-cirrhotic (NCir) and 51 with cirrhosis (Cir) confirmed by liver biopsy and/or clinical and biochemical features. When compared to the age-matched population, 25% of the patients had low BMD at the lumbar spine (LS), 26.2% at Ward's triangle, 15.5% at the femoral neck (FN), and 20.2% at the trochanter. No difference was found either between Cir and NCir groups or between sexes. Urinary N-telopeptide was increased in 31.86% of the patients, and negatively correlated with BMD at the LS and trochanter (P < 0.02). Serum bone-specific alkaline phosphatase was elevated in 21% of the patients and negatively correlated with BMD at the trochanter and Ward's triangle (P < 0.02). Fasting 25-hydroxyvitamin D was low in only three Cir patients, with no difference between the Cir and NCir groups, but it was higher in men (51.8 +/- 16.0 ng/mL) compared to women (40.4 +/- 14.4 ng/mL; P = 0.001). Fasting serum calcium was lower in Cir than NCir patients, P = 0.019. Fasting intact PTH was elevated in 42% of the patients, but the mean serum levels were similar in Cir and NCir groups.
  
  
  CONCLUSIONS
  We found no evidence of vitamin D deficiency, but cannot exclude the participation of PTH in the high bone turnover and bone loss in the population with chronic viral hepatitis.
authors.affiliation: Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil. monicapcduarte@hotmail.com
authors.forename: M P
authors.initials: MP
authors.lastname: Duarte
authors.forename: M L
authors.initials: ML
authors.lastname: Farias
authors.forename: H S
authors.initials: HS
authors.lastname: Coelho
authors.forename: L M
authors.initials: LM
authors.lastname: Mendonça
authors.forename: L M
authors.initials: LM
authors.lastname: Stabnov
authors.forename: M
authors.initials: M
authors.lastname: do Carmo d Oliveira
authors.forename: R A
authors.initials: RA
authors.lastname: Lamy
authors.forename: D S
authors.initials: DS
authors.lastname: Oliveira
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000175:diagnosis; D002118:Calcium / Q000097:blood*; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000097:blood / Q000175:diagnosis*; D010024:Osteoporosis / Q000097:blood / Q000175:diagnosis*; D010281:Parathyroid Hormone / Q000097:blood*; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood*
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium