Non-invasive assessment of bone density in primary biliary cirrhosis

Background/aims Low bone mass is an important complication of primary bilia ry cirrhosis (PBC), resulting in an increased risk of fractures and reduced mobility. In the present study, we sought to determine the frequency of lo w bone mass in PBC, and its relationship to disease severity and non-invasi ve markers of bone turnover. Methods In 36 women with PBC, bone mineral density of the lumbar spine end hip was assessed by dual emission X-ray absorptiometry. Serum and urinary m arkers of bone turnover were compared with those from age- and sex-matched controls. Results Spinal osteopenia (T score, -1.5 to -2.5) was present in 15 of the 36 patients (42%), while six others (16%) had established osteoporosis (T< -2.5). Osteopenia of the femoral neck was found in 17 patients (47%), and o steoporosis in five (14%). The severity of liver disease, as determined by Mayo Clinic R score and histological stage, correlated negatively with both regional bone mineral density and total bone mineral content expressed as a ratio to lean body mass. There was a strong positive correlation between serum levels of the procollagen degradation peptides, PICP and PIIINP (r=0. 65, P < 0.001), and both peptides correlated significantly (P < 0.001) with histological stage and Mayo Clinic R score. Fasting urinary pyridinoline a nd deoxypyridinoline to creatinine ratios were also significantly raised. Conclusions Low bone mass in PBC correlates positively with disease severit y, and is associated with a net increase in bone resorption, as assessed by urinary collagen crosslink excretion. These markers of bone turnover may b e of value in controlled clinical trials aimed at improving bone mass in PB C. Eur J Gastroenterol Hepatol 11:323-328 (C) 1999 Lippincott Williams & Wi lkins.