Primary biliary cirrhosis is not an additional risk factor for bone loss in women receiving regular calcium and vitamin D supplementation: a controlled longitudinal study.
OBJECTIVE
Alterations in bone metabolism in primary biliary cirrhosis (PBC) are generally considered to be highly prevalent and severe, but no data are available from prospective studies with adequate control groups. The aims of this study were: (1) to measure changes in bone mineral density (BMD) over time; (2) to correlate the degree of bone loss with the severity of liver disease; and (3) to characterize bone disease in PBC patients receiving regular calcium and vitamin D supplementation.


METHODS
We enrolled 118 women with PBC (mean age+/-SD: 56+/-11 y; 72% postmenopausal; 43% with cirrhosis), and measured BMD (lumbar spine, DXA-Hologic) at entry and serially over the following 5 years. The controls were 472 healthy women selected from a large observational group matched for age and menopausal status (mean age+/-SD: 55+/-10 y; 73% postmenopausal).


RESULTS
Mean BMD was 0.851+/-0.142 g/cm2 in the PBC group and 0.857+/-0.158 g/cm2 in the control group; the prevalence of osteoporosis was 28% and 29%, respectively. BMD significantly correlated with age and postmenopausal status, but not with liver cirrhosis or serum bilirubin levels. The biochemical markers of bone turnover were high in about 50% of the patients. The yearly bone loss in the PBC group was 0.008 g/cm2 (95% confidence interval: 0.014-0.003) similar to that calculated in the control group.


CONCLUSIONS
Among patients with PBC, the prevalence of osteoporosis and the yearly rate of BMD loss are similar to those observed in the general population, and are not associated with the severity of liver disease.
Benetti
Alberto
A
Division of Internal Medicine, Department of Medicine, Surgery and Dentistry, San Paolo School of Medicine, University of Milan, Milan, Italy. alberto.benetti@tiscali.it
Crosignani
Andrea
A
Varenna
Massimo
M
Giussani
Cristina Squarcia
CS
Allocca
Mariangela
M
Zuin
Massimo
M
Podda
Mauro
M
Battezzati
Pier Maria
PM
D015502:Absorptiometry, Photon; D001663:Bilirubin / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D017698:Postmenopause / Q000378:metabolism*; D015995:Prevalence; D011446:Prospective Studies; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D015675:Osteocalcin; D014807:Vitamin D; D001663:Bilirubin; D002118:Calcium