Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis

Savić, Željka; Damjanov, Dragomir; Ćurić, Nikola; Kovacev-Zavisic, Branka; Hadnadjev, Ljiljana; Novakovic-Paro, Jovanka; Nikolic, Stanislava

doi:10.4149/bll_2014_111

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…The majority of the studies on patients with cirrhosis [ 19 , 68 , 71 - 74 ] confirm the prevalence of vitamin D deficiency in this setting. The question of whether liver damage precipitates the disturbance in vitamin D homeostasis or the other way around, still remains, leading to a type of “chicken or the egg” causality dilemma.…”

Section: Discussionmentioning

confidence: 98%

Vitamin D deficiency in patients with liver cirrhosis

Konstantakis

Tselekouni

Kalafateli

et al. 2016

aog

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There is ongoing evidence that vitamin D is related to the pathophysiology of cirrhosis. Although the incidence of vitamin D deficiency in chronic liver diseases and cirrhosis is strongly documented, its pathogenic association with advanced liver fibrosis remains controversial. There is evidence of a significant relation of 25(OH)D levels with the degree of liver dysfunction, considering that an inverse correlation of 25(OH)D levels with both Child-Pugh score and Model for End-Stage Liver Disease has been reported. In addition, vitamin D deficiency has been shown to increase the risk for overall mortality and infections in patients with cirrhosis. Vitamin D deficiency has been also associated with advanced stages of hepatocellular carcinoma and poor prognosis. Finally, there are studies suggesting that patients with chronic hepatitis C and normal vitamin D levels have higher virological response to treatment. However, there are not enough studies conducted in cirrhotic-only populations. The association between vitamin D and cirrhosis demonstrates a great potential for clinical application. The relation between vitamin D deficiency and the degree of liver function, degree of fibrosis and infectious complications could support its use as a prognostic index and a diagnostic tool.

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Section: Discussionmentioning

confidence: 98%

Vitamin D deficiency in patients with liver cirrhosis

Konstantakis

Tselekouni

Kalafateli

et al. 2016

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“…With an overall rate of 32.4% of patients with primary biliary cirrhosis (PBC) and 42.3% of patients with primary sclerosing cholangitis (PSC) being affected, this group has a high prevalence of developing an osteopenia or osteoporosis [1,13,14,15,16,17,18]. With alcoholism being an independent factor for the manifestation of an osteoporosis, overall 35.9% of patients suffering from alcoholic liver disease show altered bone metabolism and structure [12,19,20,21]. Less is known about non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH).…”

Section: Hepatic Osteodystrophy—definition and Prevalencementioning

confidence: 99%

Hepatic Osteodystrophy—Molecular Mechanisms Proposed to Favor Its Development

Ehnert¹,

Aspera-Werz²,

Ruoß³

et al. 2019

IJMS

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Almost all patients with chronic liver diseases (CLD) show altered bone metabolism. Depending on the etiology, this manifests in a severe osteoporosis in up to 75% of the affected patients. Due to high prevalence, the generic term hepatic osteodystrophy (HOD) evolved, describing altered bone metabolism, decreased bone mineral density, and deterioration of bone structure in patients with CLD. Once developed, HOD is difficult to treat and increases the risk of fragility fractures. Existing fractures affect the quality of life and, more importantly, long-term prognosis of these patients, which presents with increased mortality. Thus, special care is required to support the healing process. However, for early diagnosis (reduce fracture risk) and development of adequate treatment strategies (support healing of existing fractures), it is essential to understand the underlying mechanisms that link disturbed liver function with this bone phenotype. In the present review, we summarize proposed molecular mechanisms favoring the development of HOD and compromising the healing of associated fractures, including alterations in vitamin D metabolism and action, disbalances in transforming growth factor beta (TGF-β) and bone morphogenetic protein (BMP) signaling with histone deacetylases (HDACs) as secondary regulators, as well as alterations in the receptor activator of nuclear factor kappa B ligand (RANKL)–osteoprotegerin (OPG) system mediated by sclerostin. Based on these mechanisms, we give an overview on the limitations of early diagnosis of HOD with established serum markers.

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“…Prevalence in cirrhotic patients varies from 12 to 70% according to the diagnostic approach and the liver disease etiology [2, 8, 19, 23, 24]. The initial disease that caused the liver fibrosis is important in some particular conditions, such as cholestatic diseases, in which osteoporosis prevalence seems to be higher, varying from 20 to 44% even without an established diagnosis of cirrhosis and in proportion to the degree of liver insufficiency [1, 23, 25].…”

Section: Definition and Prevalencementioning

confidence: 99%

Diagnosis and Management of Cirrhosis-Related Osteoporosis

Santos

Romeiro

2016

BioMed Research International

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Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

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Vitamin D status, bone metabolism and bone mass in patients with alcoholic liver cirrhosis

Cited by 13 publications

References 24 publications

Vitamin D deficiency in patients with liver cirrhosis

Vitamin D deficiency in patients with liver cirrhosis

Hepatic Osteodystrophy—Molecular Mechanisms Proposed to Favor Its Development

Diagnosis and Management of Cirrhosis-Related Osteoporosis

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