METABOLIC BONE-DISEASE OF LIVER-CIRRHOSIS - IS IT PARALLEL TO THE CLINICAL SEVERITY OF CIRRHOSIS

Metabolic bone disease has long been recognized in chronic liver disea se, especially cholestatic or alcoholic liver diseases. The aim of the present: study was to investigate the prevalence and severity of oste odystrophy in cirrhotic men and the correlation of its incidence with the clinical severity of cirrhosis in an endemic area of post-necrotic hepatitis. We measured serum levels of osteocalcin, 25-hydroxyvitamin D, parathyroid hormone mid-molecule, calcium and testosterone in 74 c irrhotic men (Child-Pugh's classification grade A n = 30, B n = 21 and C n = 23) and 16 healthy controls. Standard X-rays and bone mineral d ensities of lumbar spine were performed in 30 patients with post-necro tic cirrhosis and 10 healthy controls. Serum levels of osteocalcin, pa rathyroid hormone and testosterone were significantly lower in patient s with cirrhosis than in controls. Changes paralleling an increased se verity of cirrhosis were found in the serum levels of 25-hydroxyvitami n D and testosterone, but not in the serum levels of osteocalcin and p arathyroid hormone. The lumbar bone mineral density was significantly lower in patients with post-necrotic cirrhosis than in controls (0.97 +/- 0.13 vs 1.07 +/- 0.12 g/cm(2), P < 0.05) and was correlated with s erum 25-hydroxyvitamin D levels (r = 0.467; P < 0.005). There was no c orrelation between the bone mineral density and serum osteocalcin or t he clinical severity of cirrhosis. The prevalence of spinal osteoporos is, as defined by a lumbar bone mineral density greater than two stand ard deviations below the mean value of the controls, was 20% in cirrho tic patients compared with 10% in controls. Two (6.7%) patients (both grade C) had spinal compression fractures compared with none in the co ntrol group. In conclusion, serum osteocalcin and lumbar bone mineral density were significantly lower in cirrhotic men than in controls. Ho wever, they were not correlated with each other or the clinical severi ty of cirrhosis.