ackground : Osteopenia has long been recognized as a potential complication of chronic liver disease. Severe osteopenia, regardless of its cause, is a risk factor for the development of fracture, which may contribute to mortality in patients
already
debilitated by chronic liver disease. However, data on the prevalence and the severity of osteopenia in the patients with liver cirrhosis are scant in Korea.
We determined the prevalence of osteopenia in cirrhotic patients and tried to elucidate the
mechanism of osteopenia in cirrhotic patients.
Mathods : In 36 male patients with liver cirrhosis, twenty were nonalcoholics and sixteen
were alcoholics. Fifteen male controls matched in age and sex were included in this study
group. We determine of the prevalence of osteopenia using the dual energy absortiometry and
various hormones and biochemical items relevant to bone metabolism were also measured.
Results :
1) Bone density was significantly decreased in both groups of patients with liver cirrhosis,
nonalcoholics and alcoholics, compared with normal controls (p<0.05).
2) The prevalence of osteopenia of whole body was 20% in non-alcoholic cirrhotics and
25% in alcoholic cirrhotics. The most frequent site of osteopenia was lumber spine in both
groups (30%, 31%).
3) The levels of ionized calcium and 1, 25-(OH)2-D3 were significantly decreased in both
non-alcoholics and alcoholics compared with control (p<0.05). Parathyroid oid hormone didn't
show any significant difference between cirhotics and controls, but calcitonin was rather
increased in cirrhotics.
4) In cirrhotic patients with osteopenia (whole body), the levels of ionized calcium,
25-OH-D3, 1, 25-(OH)2-D3 were significantly liver cirrhotics (p<0.05).
5) Regional bone density of spine, arm, and pelvis were significantly desreased in
osteopenic cirrhotics compared with non-osteopenic cirrhotics.
Conclusions : The prevalence of osteopenia was 10-30% in non-alcoholic cirrhotics,
19-31% in alcoholic cirrhotics depending on the site studied and the most frequent site of
osteopenia was lumber spine in both groups. Decreased vitamin D and ionized calcium may
be one of various pathogenic factors involving the development of osteopenia in patients with
liver cirrhosis, and especially decreased blood level of 25-OH-D3 in cirrhotics suggested that
defect of 25-hydroxylation incirrhotic liver may be partially responsible for decreased vitamin
D.
However, further studies need to be performed to elucidate the obvious mechanism of
osteopenia according to the etiology of chirrhosis, remained liver function and the histologic
form osteopenia.
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