title: Evidence of degraded BMD and geometry at the proximal femora in male patients with alcoholic liver cirrhosis.
abstract: We examined the association of alcoholic cirrhosis in 33 patients with areal bone mineral density (BMD) and the assessed bone geometric strength of their proximal femora. Lower areal BMD, cross-sectional area and section modulus, thinner cortex, and higher buckling ratio suggest that the alcoholic liver cirrhosis is associated with lower measures of bone strength.
  
  
  BACKGROUND
  Hepatic bone disease is an important complication of chronic liver disease and is associated with significant morbidity through fractures resulting in pain, deformity, and immobility. In this study, we examined the association of alcoholic cirrhosis and liver insufficiency stage with areal bone mineral density (aBMD) and additionally employed hip structure analysis (HSA) as an advanced method to assess bone geometric strength of the proximal femur in men with alcoholic liver cirrhosis.
  
  
  METHODS
  The study included 33 male patients with alcoholic liver cirrhosis and a control group of 36 healthy patients. Laboratory testing included the following biochemical markers of bone turnover: serum levels of osteocalcin and C-telopeptide of type 1 collagen. Areal BMD was measured by dual x-ray absorptiometry on the proximal femora. Structural parameters were then derived from these scans using hip structure analysis software.
  
  
  RESULTS
  After adjusting for age, body height, and weight, we found lower cross-sectional area (p = 0.005) and section modulus (p = 0.005), thinner cortex (p = 0.012), and higher buckling ratio (p = 0.043) in the neck region among patients with cirrhosis. The findings suggest that alcoholic liver cirrhosis is associated with lower measures of bone strength. These findings were consistent with decreased osteocalcin values and increased C-telopeptide of type 1 collagen in patients with cirrhosis, indicating reduction in bone formation and increased bone resorption.
  
  
  CONCLUSIONS
  Our results emphasize that HSA-derived structural indices of proximal femoral structure may be an important index of greater fragility in patients with alcoholic cirrhosis.
authors.affiliation: Clinic of Gastroenterology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dj
authors.initials: Dj
authors.lastname: Culafić
authors.forename: D
authors.initials: D
authors.lastname: Djonic
authors.forename: V
authors.initials: V
authors.lastname: Culafic-Vojinovic
authors.forename: S
authors.initials: S
authors.lastname: Ignjatovic
authors.forename: I
authors.initials: I
authors.lastname: Soldatovic
authors.forename: J
authors.initials: J
authors.lastname: Vasic
authors.forename: T J
authors.initials: TJ
authors.lastname: Beck
authors.forename: M
authors.initials: M
authors.lastname: Djuric
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D024042:Collagen Type I / Q000097:blood; D005272:Femur Neck / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010455:Peptides / Q000097:blood
chemical_list: D024042:Collagen Type I; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin