Bone mineral density and disorders of mineral metabolism in chronic liver disease.
OBJECTIVE
To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis.


METHODS
The study was performed on 72 Indian patients with cirrhosis (63 male, nine female; aged < 50 years). Etiology of cirrhosis was alcoholism (n = 37), hepatitis B (n = 25) and hepatitis C (n = 10). Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density (BMD) was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2.


RESULTS
Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium: protein ratio and calcium: phosphorus ratio. Vitamin D deficiency was highly prevalent (92%). There was a high incidence of hypogonadism (41%). Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor (IGF) 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low (68%) and urinary deoxypyridinoline to creatinine ratio was high (79%), which demonstrated low bone formation with high resorption.


CONCLUSIONS
Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.
George
Joe
J
Department of Endocrinology, KEM Hospital, Parel, Mumbai 400012, India.
Ganesh
Hosahithlu K
HK
Acharya
Shrikrishna
S
Bandgar
Tushar R
TR
Shivane
Vyankatesh
V
Karvat
Anjana
A
Bhatia
Shobna J
SJ
Shah
Samir
S
Menon
Padmavathy S
PS
Shah
Nalini
N
D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D004032:Diet; D004967:Estrogens / Q000378:metabolism; D005260:Female; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D013472:Sunlight; D055815:Young Adult
D004967:Estrogens; C515497:IGFBP3 protein, human; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D007334:Insulin-Like Growth Factor I