Om. Crosbie et al., Bone density, vitamin D status, and disordered bone remodeling in end-stage chronic liver disease, CALCIF TIS, 64(4), 1999, pp. 295-300
Hepatic osteodystrophy occurs in up to 50% of patients with chronic liver d
isease (CLD). The aim of this study was to determine the relative contribut
ion of increased resorption and decreased formation to hepatic osteodystrop
hy by measuring biochemical markers. Twenty-seven patients with advanced CL
D (14 female, 13 male) were enrolled. Bone mineral density (BMD), measured
at the lumbar spine, and femoral neck, were measured by dual energy X-ray a
bsorptiometry (DXA); bone turnover was assessed using biochemical markers o
f bone formation and resorption. Based on WHO criteria, osteoporosis and os
teopenia were present in 41% and 18% of patients, respectively. All three m
arkers of bone resorption (free deoxypyridinoline, pyridinoline, and hydrox
yproline) were increased significantly in patients with CLD. There was a le
ss marked change in the markers of bone formation (osteocalcin, procollagen
type 1 peptide, and bone alkaline phosphatase), resulting in a negative un
coupling index in 23/27 (85%) of the patients. Only two (7%) patients had b
iochemical changes consistent with osteomalacia. The results suggest that i
ncreased bone resorption is the predominant cause of hepatic osteodystrophy
and therapeutic strategies should be designed to suppress bone resorption,
especially in preparation for liver transplantation. Bone biomarkers may b
e useful alternatives to bone biopsy in evaluating hepatic osteodystrophy.