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 D-3 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 D-3, PTH, osteocalcin and beta-carboxy-terminal cross-linked telopeptide of type I collagen (beta-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 beta-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 beta-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 beta-CTX are not valid indicators of decreased BMD, but their values correlate with the degree of liver insufficiency.