Optimization of Antiosteoporotic Therapy in Patients with Liver Fibrosis

Abstract

The purpose of the study: to investigate the effect of zolendronic acid on bone mineral density in patients with osteoporosis and fibrotic changes of the liver due to steatohepatitis. Materials and methods. We examined 28 female patients with a mean age of 55.3±4.7 years with decreased bone mineral density, nonalcoholic steatohepatosis and liver fibrosis. All studied patients were in menopause duration of 7.8±3.5 years. For inclusion in the study, all patients were excluded from the presence of comorbidities. The degree of liver fibrosis was determined on the basis of 2D shear wave elastometry by transcutaneous access by the method of shear wave in the SWE mode. The study included patients with liver fibrosis F1 - F3 on METAVIR. Determination of bone mineral density was performed using an X-ray densitometer DEXXUM T by dual energy absorption. Results and discussion. The initial level of liver tissue stiffness in the studied patients was 8.52±1.12 kPa, which corresponded to the stage of fibrosis F2 - F3 according to METAVIR. Isolated decrease in lumbar spine mineral density was diagnosed in 20 patients, 8 patients had a combination of decreased spinal mineral density with decreased femoral mineral density, mean T vertebral T-test was -2.25±0.2, mean femoral neck T-test was -1, 9±0.3. In order to maintain and restore bone mineral density, these patients were advised to minimize the factors that contribute to bone loss, mainly by stopping alcohol and smoking. Patients were advised to exercise as much as possible under the supervision of a rehabilitologist, especially to do exercises aimed at improving the mechanics of the spine. One year after administration of 5 mg zolendronic acid intravenously and daily intake of 1500 mg calcium and 800 IU vitamin D the level of liver tissue stiffness in the studied patients was 7.69±1.14 kPa, which corresponded to the stage of fibrosis F2 - F3 according to METAVIR and not due to a moderate decrease in indicators, there was no statistically significant difference. Isolated decrease in lumbar spine mineral density was diagnosed in 19 patients, in 9 patients there was a combination of decrease in spinal mineral density with decrease in femur mineral density, the average criterion of T vertebrae was 1.1±0.3 (p=0.032), the average criterion of T femoral neck -0.9±0.3 (p=0.029). The study of the level of alaline transaminase, aspartate transaminase, alkaline phosphatase, gamma-glutamyltranspeptidase did not reveal any abnormalities. After administration of zolendronic acid in 7 patients there was an increase in temperature to febrile levels within 2-3 days. None of the patients showed signs of bone fractures of any localization during the observation period. Conclusion. Thus, the administration of zolendronic acid to patients with decreased bone mineral density on the background of fibrous changes in liver tissue due to steatohepatitis is safe and highly effective