The clinical importance of biochemical bone markers in patients with alcoholic and viral liver cirrhosis

Abstract

Background: Metabolic bone disease in patients with chronic liver disease is called hepatic osteodystrophy and is primarily a sequel to osteopenia/osteoporosis, and rarely secondary to osteomalacia. The aim of this work was to define the influence of vitamin D3 and parathyroid hormone (PTH) in the pathogenesis of hepatic osteodystrophy, as well as the predictive significance of biochemical bone markers. Methods: This prospective study included 58 male patients with alcoholic (49) and viral (9) cirrhosis. The concentrations of serum vitamin D3, PTH, osteocalcin and ß-carboxy-terminal cross-linked telopeptide of type I collagen (ß-CTX) were determined. Bone density was measured by dual energy X-ray absorptiometry in the L1-L4 spinal segment and the femoral neck. Results: Lower bone mineral density (BMD) was measured in 41 patients (70.7%). There was no significant correlation between PTH and vitamin D3 values and T score in the femoral neck (p = 0.51; p = 0.063) and lumbar spine (p= 0.49; 0.064). Also, no significant correlation was found between the osteocalcin values in lumbar spine BMD (p= 0.944) and femoral neck (p= 0.161), or with ß-CTX values and BMD in the lumbar spine (p=0.347) and femoral neck (p=0.73). Statistically significant difference was confirmed between the stage A osteocalcin (p=0.000) and ß-CTX (p=0.008) values in relation to advanced stages B and C. Conclusions: PTH and vitamin D3 do not influence the development of hepatic osteodystrophy. In patients with cirrhosis, osteocalcin and ß-CTX are not valid indicators of decreased BMD, but their values correlate with the degree of liver insufficiency.

Keywords

• liver cirrhosis
• osteoporosis
• osteocalcin
• ß-ctx