Bone density, vitamin D status, and disordered bone remodeling in end-stage chronic liver disease

Hepatic osteodystrophy occurs in up to 50% of patients with chronic liver disease (CLD). The aim of this study was to determine the relative contribution of increased resorption and decreased formation to hepatic osteodystrophy by measuring biochemical markers. Twenty-seven patients with advanced CL...

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Bibliographic Details
Published in:Calcified tissue international 1999-04, Vol.64 (4), p.295-300
Main Authors: Crosbie, O M, Freaney, R, McKenna, M J, Hegarty, J E
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Adult
Aged
Biomarkers - analysis
Bone Demineralization, Pathologic - physiopathology
Bone Density
Bone Remodeling - physiology
Calcifediol - analysis
Calcium - analysis
Chronic Disease
Female
Humans
Liver Diseases - physiopathology
Male
Middle Aged
Risk Factors
Vitamin D - metabolism
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Summary:Hepatic osteodystrophy occurs in up to 50% of patients with chronic liver disease (CLD). The aim of this study was to determine the relative contribution of increased resorption and decreased formation to hepatic osteodystrophy by measuring biochemical markers. Twenty-seven patients with advanced CLD (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 absorptiometry (DXA); bone turnover was assessed using biochemical markers of bone formation and resorption. Based on WHO criteria, osteoporosis and osteopenia were present in 41% and 18% of patients, respectively. All three markers of bone resorption (free deoxypyridinoline, pyridinoline, and hydroxyproline) were increased significantly in patients with CLD. There was a less marked change in the markers of bone formation (osteocalcin, procollagen type 1 peptide, and bone alkaline phosphatase), resulting in a negative uncoupling index in 23/27 (85%) of the patients. Only two (7%) patients had biochemical changes consistent with osteomalacia. The results suggest that increased 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 be useful alternatives to bone biopsy in evaluating hepatic osteodystrophy.
ISSN:0171-967X
1432-0827
DOI:10.1007/s002239900622