title: Bone Mineral Density, Bone Turnover, and Systemic Inflammation in Non-cirrhotics with Chronic Hepatitis C.
abstract: BACKGROUND
  Whether chronic HCV, a disease characterized by systemic inflammation, impacts bone mineral density (BMD) independent of cirrhosis is unknown.
  
  
  OBJECTIVE
  We aimed to evaluate the association between BMD, systemic inflammation, and markers of bone turnover in chronic HCV without cirrhosis.
  
  
  METHODS
  Non-cirrhotics, 40-60 years old, with chronic HCV underwent measurement of: (1) BMD by dual-energy X-ray absorptiometry scan and (2) serum markers of systemic inflammation and bone turnover. By Chi-squared or t test, we compared those with normal versus low BMD.
  
  
  RESULTS
  Of the 60 non-cirrhotics, 53 % were female and 53 % Caucasian. Mean (SD) age was 53.3 years (5.7), total bilirubin 0.7 mg/dL (0.3), creatinine 0.8 mg/dL (0.2), and body mass index 28.4 kg/m(2) (6.5). Low BMD was observed in 42 %: 30 % had osteopenia, 12 % had osteoporosis. Elevated tumor necrosis factor α, interleukin-6, and C-reactive protein levels were found in 26, 32, and 5 %, respectively, but did not differ by BMD group (p > 0.05). Patients with low BMD had higher serum phosphorus (4.1 vs. 3.5 mg/dL) and pro-peptide of type 1 collagen (P1NP; 73.1 vs. 47.5 ng/mL) [p < 0.05], but similar bone-specific alkaline phosphatase, serum C-telopeptide, and parathyroid hormone levels.
  
  
  CONCLUSIONS
  Low BMD is prevalent in 40- to 60-year-old non-cirrhotics with chronic HCV, but not associated with systemic inflammatory markers. Elevated P1NP levels may help to identify those at increased risk of bone complications in this population. Chronic HCV should be considered a risk factor for bone loss, prompting earlier BMD assessments in both men and women.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA, 94143, USA, jennifer.lai@ucsf.edu.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lai
authors.forename: Dolores M
authors.initials: DM
authors.lastname: Shoback
authors.forename: Jacob
authors.initials: J
authors.lastname: Zipperstein
authors.forename: Blanca
authors.initials: B
authors.lastname: Lizaola
authors.forename: Samuel
authors.initials: S
authors.lastname: Tseng
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008103:Liver Cirrhosis / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers