DOI: http://dx.doi.org/10.18203/2349-3933.ijam20202121

A cross-sectional study of chronic liver disease patients complicating to hepatic osteodystrophy

Mohammed Jaleel P., S. Bhagyabati Devi, Ningthoukhongjam Reema, Thangjam Gautam Singh, Dhileeban Maharajan P.

Abstract


Background: Hepatic osteodystrophy encompasses the spectrum of metabolic bone diseases in chronic liver disease (CLD) patients. CLD causing changes in BMD is well known. Although BMD evaluation in CLD cirrhosis are recommended by societies of British and American gastroenterology ,very less number of literature exist from India and none from the North-eastern region of India. Aim of the study to determine the association and severity of bone mineral density changes in patients with CLD and to correlate it with different aetiologies and severity of CLD.

Methods: This cross-sectional study which included 79 patients with CLD was conducted in RIMS, Manipur from September 2017 to August 2019. All CLD patients of age 18-60 years were included. DEXA scan and other related blood investigations were performed.

Results: Chronic alcohol intake (56.9%), viral infection (20.3%) and mixed (17.7%) were the main aetiology of CLD in our study. Seventy three (92.4%) of the total 79 patients had low BMD (Osteopenia in 29 (36.7%) and osteoporosis in 44 (55.7%) patients). Osteoporosis was detected in 53.4% of alcohol related Cirrhosis, 25%of viral liver disease. Majority of the severe CLD patients (Child class C) had osteoporosis (70.6%) as compared to less severe groups (23.5% and 36.4% in class B and A respectively).

Conclusions: CLD patients have high prevalence of osteoporosis. Severity of liver disease, alcoholic liver disease, serum calcium and vitamin D deficiency predisposes to osteoporosis in these patients. Hence early screening of BMD is necessary in CLD patients.


Keywords


Bone mineral density, Chronic liver disease, Hepatic osteodystrophy, Osteoporosis

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References


World Health Rankings. World Health Organization 2017. Available at: http:// www.worldlifeexpectancy.com/india-liver-disease. Accessed on 10 July 2018.

Tahir A, Malik RF, Ahmad I, Krishin J, Akhtar P. Aetiological factors of chronic liver disease in children. J Ayub Med Coll Abbottabad. 2011;23(2):12-4.

Angulo P, Machado MV, Diehl AM. Fibrosis in nonalcoholic fatty liver disease: Mechanisms and clinical implications. Semin Liver Dis. 2015;2(1):132-45.

Sudeshna M, Kumkum S, Mehebubar R, Soumendra NH. Clinical and etiological study on chronic liver diseases. Int J Contemp Medi Surg Radiol. 2018;3(2):77-80.

Nakchbandi IA, van der Merwe SW. Current understanding of osteoporosis associated with liver disease. Nat Rev Gastroenteral Hepatol. 2009;6(11):660-70.

Dempster DW, Lindsay R. Pathogenesis of osteoporosis. Lancet. 1993;341(1):797-801.

Hay JE. Osteoporosis in liver diseases and after liver transplantation. J Hepatol. 2003;38:856-65.

Rouillard S, Lane NE. Hepatic osteodystrophy. Hepatology. 2001;33:301-07.

George J, Ganesh HK, Acharya S, Bandgar TR, Shivane V, Karvat A, et al. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol. 2009;15(28):3516-22.

Sachdev S, Bhasin RC, Kumari CK, Reys M. A study of metabolic bone disorder in cirrhosis liver. J Assoc Physic Ind. 1976;24:5-11.

Hay JE, Guichelaar MM. Evaluation and management of osteoporosis in liver disease. Clin Liver Dis. 2005;9(1):747-66.

Guarino M, Loperto I, Camera S, Cossiga V, Di Somma C, Colao A, et al. Osteoporosis across chronic liver disease. Osteopor Int. 2016;27(6):1967-77.

Ringe JD, Kipshoven C. Vitamin D-insufficiency: An estimate of the situation in Germany. Dermatoendocrinol. 2012;4(1):72-80.

Huang Z, Wei H, Cheng C, Yang S, Wang J, Liu X. Low bone mineral density in chronic hepatitis B virus infection: A case-control study. Pak J Med Sci. 2017;33(2):457-61.

Moschen AR, Kaser A, Stadlmann S, Millonig G, Kaser S, Mühllechner P, et al. The RANKL/OPG system and bone mineral density in patients with chronic liver disease. J Hepatol. 2005;43:973-83.

Szalay F, Hegedus D, Lakatos PL, Tornai I, Bajnok E, Dunkel K, et al. High serum osteoprotegerin and low RANKL in primary biliary cirrhosis. J Hepatol. 2003;38:395-400

González-Calvin JL, Mundi JL, Casado-Caballero FJ, Abadia AC, Martin-Ibañez JJ. Bone mineral density and serum levels of soluble tumor necrosis factors, estradiol, and osteoprote-gerin in postmenopausal women with cirrhosis after viral hepatitis. J Clin Endocrinol Metab. 2009;94:4844-50

López-Larramona G, Lucendo AJ, González-Castillo S, Tenias JM. Hepatic osteodystrophy: An important matter for consideration in chronic liver disease. World J Hepatol. 2011;3(12):300-07.

Mukherjee PS, Vishnubhatla S, Amarapurkar DN. Etiology and mode of presentation of chronic liver diseases in India: A multi centric study. PLoS One. 2017;12(10):e0187033.

Berg KM, Kunins HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121:406-18

Sharma B, Marwaha R, Raina S, Sharma N. Etiological profile of cirrhosis in a hilly state of North India. J Clin Exp Hepatol. 2015;5(1):46-9.

Perme O, Singh YI, Singh KR, Devi BS, Rao A, Singh SK. Prevalence of diabetes in chronic liver disease patient admitted in medicine ward in RIMS Hospital, Imphal. J Med Soc. 2016;30(2):84-8.

Ray G. Trends of chronic liver disease in a tertiary care referral hospital in Eastern India. Ind J Pub Health. 2014;58(3):186-9.

Arora AC, Manocha RG, Prasad S. Hepatic osteodystrophy: A study of the prevalence of osteoporosis in cirrhosis of liver and its correlation with severity of liver disease. Ind Assoc Clin Medi. 2017;18(1):36-9.

Monegal A, Navasa M, Guanabens N, Peris P, Pons F, Martinez OMJ, et al. Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation. Calcif Tissue Int. 1997;60(2):148-54.

Nicoll R, Black A, Bailey L, Dundas P, McLeman L, Vijayan B, et al. Fracture risk calculation tool enhances dual-energy X-ray absorptiometry scan referral pathway in cirrhosis patients. Eur J Gastroenterol Hepatol. 2016;28(7):757-61.

Patil S, Nagarajan K, Vadukot M, Nair H. Hepatic Osteodystrophy: Prevalence and correlation with aetiology and functional class. Clin Exp Hepatol. 2015;5(2):40-5.

Diamond TH, Stiel D, Lunzer M, McDowall D, Eckstein RP, Posen S. Hepatic osteodystrophy: static and dynamic bone histomorphometry and serum bone Gla-protein in 80 patients with chronic liver disease. Gastroenterology. 1989;96(1):213-21.

Loria I, Albanese C, Giusto M, Galtieri PA. Bone disorders in patients with chronic liver disease awaiting liver transplantation. Transplant Proc 2010;42(4):1191-3.

Karoli Y, Karoli R, Fatima J, Manhar M. Study of Hepatic osteodystrophy in Patients with Chronic liver disease. J Clin Diagn Res. 2016;10(8):31-4.