Osteodystrophy in patients with chronic hepatitis and liver cirrhosis

Tsuneoka, Katsunobu; Tameda, Yukihiko; Takase, Koujirou; Nakano, Tomoya

doi:10.1007/bf02347615

Cited by 74 publications

(56 citation statements)

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“…Hypogonadism, abnormalities of vitamin D metabolism, and increased bilirubin levels, situations usually found in chronic liver disease, may lead to either reduced bone formation or increased bone resorption [23][24][25]. The results from the studies that have investigated the impact of hepatitis C on osteoporosis of hemophilia patients are conflicting.…”

Section: Discussionmentioning

confidence: 99%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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International audienceOsteoporosis has been recently recognized as a severe comorbidity factor in hemophilia. However, its pathogenesis is still obscure. We evaluated the incidence of osteoporosis in 90 hemophilia patients and investigated possible correlations with clinical and laboratory data. Out of the 90 patients, 80 (89%) had severe hemophilia, and 35 (38.9%) were human immunodeficiency virus (HIV)-positive. Hemophilic arthropahty was assessed using World Federation of Hemophilia clinical score and Petterson radiological score. Bone mineral density of the lumbar spine (LS) and femoral neck (FN) were measured using dual-energy X-ray absortiometry. Bone turnover was evaluated by the measurement of: (1) bone resorption markers [N-terminal cross-linking telopeptide of collagen type I (NTX), C-terminal cross-linking telopeptide of collagen type I (CTX), and tartrate-resistant acid phosphatase isoform-5b (TRACP-5b)], (2) bone formation markers [bone-alkaline phosphatase (bALP) and osteocalcin], and (3) osteoclast stimulators (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tumor necrosis factor-alpha). Osteopenia or osteoporosis was observed in 86% and 65% of the patients in FN and LS, respectively. Osteoporosis was more common among HIV-positive patients in both FN (65.3% vs 41.6%; = 0.007) and LS (17.86% vs 5.41%, = 0.004). The severity of osteoporosis in FN correlated with the patients' total clinical and radiological score ( = 0.001). Hemophilia patients showed increased osteoclastic activity (significant increase of TRACP-5b, NTX, and CTX), which was not accompanied by a comparable increased bone formation (reduced osteocalcin and borderline increase of bALP). In multivariate analysis, HIV infection ( = 0.05) and total clinical score ( = 0.001) were independent risk factors for osteoporosis development. We conclude that there is a high prevalence of osteoporosis among hemophiliacs, which is related to the severity of arthropathy and is enhanced by HIV infection. We report for the first time a high bone resorption that seems not to be balanced by a comparable bone formation

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Section: Discussionmentioning

confidence: 99%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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“…The intestinal absorption of cholecalciferol (vitamin D3) and 25-hydroxycholecalciferol is affected only in the presence of severe cholestasis. Experimental studies have demonstrated that hepatic 25-hydroxylation of vitamin D3 is not impaired in cirrhotic rats, however, there is no evidence in humans [2].…”

Section: Introductionmentioning

confidence: 97%

“…Vitamin D is hydroxylated by liver to 25-hydroxy vitamin D, the main circulating form, and then is converted into the active form 1, 25-dihydroxyvitamin D in kidney [1,2]. Given that liver is involved in bile salt production, absorption of vitamin D, and 25-hydroxylation of vitamin D, it might be expected that vitamin D deficiency would be common in patients with chronic liver disease (CLD) [2].…”

Section: Introductionmentioning

confidence: 99%

Disturbances of parathyroid hormone–vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study

et al. 2010

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Purpose Liver has an important role in metabolism of vitamin D. This study aimed to evaluate the patterns of vitamin D-parathyroid hormone (PTH) disturbance and correlate it in patients with non-cholestatic chronic liver disease (CLD). Methods A total of 40 healthy controls and 90 consecutive patients with evidence of non-cholestatic CLD due to hepatitis C (n = 28), hepatitis B (n = 26), autoimmune hepatitis (n = 19), and cryptogenic causes (n = 17) were enrolled. Cirrhosis was evident in 51 patients. Serum concentrations of 25-hydroxy vitamin D, PTH, calcium, phosphate, and liver enzymes were measured. Child-Pugh classification was determined in cirrhotic patients. Results Vitamin D deficiency (\50 nmol/l) was found in 46 (51.1%) patients and vitamin D insufficiency (50-80 nmol/l) in 15 (16.7%) patients. Secondary hyperparathyroidism (serum PTH [ 6.8 pmol/l) was present in 6 (6.7%) patients. The prevalence of vitamin D deficiency was significantly higher in cirrhotic versus noncirrhotic patients (76.5 vs. 17.9%; P \ 0.001), whereas there was no significant difference in serum calcium, phosphate, and PTH levels. ChildPugh class B and C patients had significantly lower vitamin D level compared with class A patients (P \ 0.001), whereas there was no significant difference in serum calcium, phosphate, and PTH levels. No significant correlation was seen between vitamin D and PTH, calcium or phosphate levels. Lower serum level of vitamin D was associated with coagulopathy, hyperbilirubinemia, hypoalbuminemia, anemia, and thrombocytopenia. Conclusions Vitamin D inadequacy and the severity of liver dysfunction move in parallel in patients with noncholestatic CLD. Vitamin D assessment and replacement should be considered in the management of patients with non-cholestatic CLD.

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“…[9][10][11][12][13] In a study performed by Tsuneoka et al in 1993Tsuneoka et al in -1994 non-cirrhotic subjects with chronic viral hepatitis due to HBV (n=8) and HCV (n=12) were compared for bone metabolism with cirrhotic patients and also with age-sex matched healthy volunteers. 9 BMD was significantly decreased in patients with liver cirrhosis and, to a lesser extent, in patients with chronic hepatitis, compared with healthy subjects. In another study, Schiefke et al investigated BMD and bone turnover markers in biopsy-proven non-cirrhotic 43 patients (30 with HCV and 13 with HBV) with viral hepatitis.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Osteodystrophy in patients with liver cirrhosis secondary to viral hepatitis has been well defined; however, there is little information about occurrence of bone disease in non-cirrhotic patients with chronic viral hepatitis, especially in asymptomatic hematite B virus (HBV) carriers. [9][10][11][12][13] Therefore, the aim of this study was to evaluate the bone mineral density (BMD) and the biochemical markers relevant the bone turnover in non-cirrhotic patients with chronic viral hepatitis B.…”

mentioning

confidence: 99%

Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients with non-Cirrhotic Chronic Hepatitis B

Çelebi¹,

Sarıkaya²,

Özdolap³

et al. 2012

Turkiye Klinikleri J Med Sci

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324lteration in mineral amount of bone is a common complication of chronic liver disease.1,2 Hepatic osteodystrophy, described by Heaf, is a general definition that describes abnormalities in mineral density Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients withnon-Cirrhotic Chronic Hepatitis BA AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the bone mineral density (BMD) and the biochemical markers of bone turnover in non-cirrhotic chronic hepatitis B patients. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We compared 18-65 years old non-cirrhotic chronic hepatitis B patients and healthy controls for BMD and biochemical markers of bone turnover. BMD was measured at the lumbar spine and the left hip using DXA. R Re es su ul lt ts s: : There were 31 hepatitis B patients (19 males, 12 females) and 72 healthy controls (56 males, 16 females) in the study. Their mean age was 37.4 ± 10.0 years in the study group and 38.5 ± 7.1 years in the controls. There were no differences between the two groups for the mean BMD levels and T scores. However, left hip BMD and T scores were significantly lower in male patients with chronic hepatitis B infection when compared to males in the control group. Serum calcium, phosphate, osteocalcine, intact parathyroid hormone, deoxypyridinoline and 25-hydroxycholecalciferol levels did not differ between the groups. C Co on nc cl lu us si io on n: : In our study, left hip BMD and T scores were found to be significantly lower in the male patients with chronic hepatitis B infection when compared to males in the control group, however a significant difference was not detected when all cases were compared with the control group. Therefore, we suppose that further studies on a larger population are needed in this issue.K Ke ey y W Wo or rd ds s: : Hepatitis B virus; chronic hepatitis B; bone density Ö ÖZ ZE ET T A Am ma aç ç: : Sirotik olmayan kronik hepatit B'li hastalarda kemik mineral yoğunluğu (KMY) ve kemik döngüsü biyokimyasal parametrelerini değerlendirmektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Yaşları 18-65 arasında olan, sirotik olmayan kronik hepatit B'li hastaların ve sağlıklı olguların KMY ve kemik döngüsü biyokimyasal parametrelerini karşılaştırdık. KMY ölçümü, DXA yöntemi ile lomber omurga ve sol kalça bölgesinden yapıldı. B Bu ul lg gu ul la ar r: : Çalışmaya 31 hepatit B hastası (19 erkek, 12 kadın) ve 72 sağlıklı kişi (56 erkek, 16 kadın) alınmıştır. Yaş ortalaması kronik hepatit B'li grupta 37,4±10 yıl, sağlıklı kontrol grubunda 38,5±7,1 yıl olarak hesaplandı. Ortalama KMY değerleri ve T skorları açısından iki grup arasında anlamlı fark saptanmadı. Ancak, sol kalça KMY ve T skorları kronik hepatit B'li erkek hastalarda kontrol grubundaki erkeklere göre anlamlı ölçüde daha düşük bulunmuştur. Serum kalsiyum, fosfat, osteokalsin, aktif parathormon, deoksipiridinolin ve 25-hidroksikalsiferol seviyeleri yönünden iki grup arasında anlamlı fark saptanmamıştır. S So on nu uç ç: : Çalışmamızda kronik hepatit B'li...

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Osteodystrophy in patients with chronic hepatitis and liver cirrhosis

Cited by 74 publications

References 20 publications

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

Disturbances of parathyroid hormone–vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study

Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients with non-Cirrhotic Chronic Hepatitis B

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