Bone mineral density and disorders of mineral metabolism in chronic liver disease

被引:87
|
作者
George, Joe
Ganesh, Hosahithlu K.
Acharya, Shrikrishna
Bandgar, Tushar R. [1 ]
Shivane, Vyankatesh
Karvat, Anjana
Bhatia, Shobna J. [2 ]
Shah, Samir [3 ]
Menon, Padmavathy S.
Shah, Nalini
机构
[1] King Edward Mem Hosp, Dept Endocrinol, Seth GS Med Coll, Bombay 400012, Maharashtra, India
[2] Seth GS Med Coll, Dept Gastroenterol, Bombay 400012, Maharashtra, India
[3] Jaslok Hosp, Dept Gastroenterol, Bombay 400026, Maharashtra, India
关键词
Bone mineral density; Liver disease; Chronic disease; Cirrhosis; Bone mineral metabolism; Hepatic osteodystrophy; GROWTH-FACTOR-I; CIRRHOSIS; OSTEOPOROSIS; HORMONE; TRANSPLANTATION; HEPATITIS; PROTEIN;
D O I
10.3748/wjg.15.3516
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
AIM: To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS: The study was performed on 72 Indian patients with cirrhosis (63 male, 9 female; aged < 50 years). Etiology of cirrhosis was alcoholism (n = 37), hepatitis B (n = 25) and hepatitis C (n = 10). Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density (BMD) was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS: Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium: protein ratio and calcium: phosphorus ratio. Vitamin D deficiency was highly prevalent (92%). There was a high incidence of hypogonadism (41%). Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor (IGF) 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low (68%) and urinary deoxypyridinoline to creatinine ratio was high (79%), which demonstrated low bone formation with high resorption. CONCLUSION: Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level. (C) 2009 The WIG Press and Baishideng. All rights reserved.
引用
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页码:3516 / 3522
页数:7
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