OSTEOPOROSIS ASSOCIATED WITH CHRONIC LIVER-DISEASE

Bone mineral density in spinal trabecular and peripheral cortical bone was measured in 64 unselected patients with chronic liver disease, using quantitative computed tomography and single-photon absorptiometry. Fourteen patients (22%) had bone mineral density values > 2 s.d. below the age- and sex-matched control values; of these, values were low in spinal trabecular bone in six (9%) and in cortical bone in 10 (16%). Four of the six patients with low spinal bone mineral density values had corticosteriod-treated chronic active hepatitis and the mean bone mineral density in all steroid-treated patients, expressed as a percentage of the normal value, was lower than in non-steroid treated patients (85.8 versus 101%). Four patients had vertebral compression fractures; three of these had alcoholic liver disease, of whom two had normal spinal bone mineral density. These results demonstrate some increase in the prevalence of cortical and trabecular osteoporosis in chronic liver disease and provide evidence that spinal trabecular osteoporosis is a consequence of steroid therapy rather than the liver disease per se.