FREQUENCY OF OSTEOPOROSIS IN PATIENTS WITH CIRRHOSIS DUE TO HEPATITIS B AND HEPATITIS C: A STUDY OF 100 CASES
AbstractBackground: Osteoporosis is the disease of bone that affected King David of Israel 3000 years ago.This condition is no longer considered to be due to aging alone and is increasingly recognised as amajor health concern and accounts for about 1.5 million fractures annually in United States. Objectiveof this study was to see the frequency of osteoporosis in patients with cirrhosis due to Hepatitis B andC, and any correlation between the Bone Mineral Density (BMD) and duration and stage of the liverdisease. Methods: The study was conducted in the Department of Gastroenterology, PostgraduateMedical Institute, Hayatabad Medical Complex, Peshawar, from January 2008 to December 2008. Allpatients from the OPD or Ward fulfilling the criteria and consenting were included. Physicalexamination, with special emphasis on any signs of chronic liver disease was performed. Full bloodcount, platelet count, prothrombin time and INR, liver function tests including serum albumin, andrenal function tests were done on all patients. Viral serology was checked for those patients who wereeither newly diagnosed as cirrhotic or were cirrhotic but not screened for viral markers. Abdominalsonogram was recorded on all patients. The Child’s score was calculated for each patient using theclinical and lab parameters. The BMD was calculated for all patients using computer based ultrasoundprobe. Calcaneum was used for evaluation of BMD. The information collected was entered onstructured data collection sheets and was analysed using SPSS version 11. Results: Osteoporosis wasfound in 26% of subject and osteopenia in 42%, while 32% had BMD in the normal range. The mean Tscore was -1.483 (±1.29). The mean duration of liver disease was 3.77 (±1.56) year. Majority of thepatients (81%) were in Child’s Class C, followed by Class B and A (16% and 3% respectively). Fiftynine percent of the patients were males with a mean age of 37.65 years, while 41% were females withmean age of 37.76 years. Conclusion: Osteoporosis is a common finding in patients with cirrhosis dueto Hepatitis B and C. Osteoporosis is more frequent in patients with long duration of liver disease butthere is no significant correlation between the aetiology or severity of liver disease and osteoporosis.Keywords: BMD, T score, Child’s score, Cirrhosis, Hepatitis B, Hepatitis C, Osteoporosis
Heneghan MA, O’Beirne JP. Clinical manifestations of liver
disease. In: Bacon BR, O’Grady JD, Di Bisceglie AM, Lake
JR editors.Comprehensive clinical Hepatology. 2nd ed, USA:
Elsevier Mosby; 2006.p.196.
Noun B, Louba L. What was the disease of the bones that
affected King David? J Gerontol A Biol Sci Med Sci. J
Gastroenterol 2002; 57:M152–4.
Usman J, Siddique H. Osteoporosis in family practice. J Pak
Med Assoc 2003;53:433–6.
J Ayub Med Coll Abbottabad 2009;21(3)
Eastell R, Dickson ER, Hodgson SF, Wiesner RH, Porayko
MK,Wahner HW. Rates of vertebral bone loss before and
after liver transplantation in women with primary biliary
cirrhosis. Hepatology 1991;14:296–300.
Bonkovsky HL,Hawkins M, Steinberg K, Hersh T, Galambos JT,
Henderson JM, et al. Prevalence and prediction of osteopenia in
chronic liver disease. Hepatology 1990;12:273–80.
Stellon AJ, Webb A, Compston J, Williams R. Lack of
osteomalacia in chronic cholestatic liver disease. Bone
Hussaini HS, Stewart SP, Roman F, Oldroyd B, Bramley P,
Simpson M, et al. Osteoporosis after liver transplantation: an
overestimated risk? Gut 1995;36:A20.
Cijevschi C, Mihai C, Zbranca E, Gogalniceanu P.
Osteoporosis in liver cirrhosis. Rom J Gastroenterol
Diamond TH, Steil DL, Unzer M. Hepatic osteodystrophy–
static and dynamic bone histomorphometry and serum bone
gla-protein in 80 patients with chronic liver disease.
Lindor KD. Management of osteopenia of liver disease with
special emphasis on primary biliary cirrhosis. Semin Liver
Conte D, Caraceni MP, Duriez J, Mandello C,Corghi E,
Cesana M. Bone involvement in primary hemochromatosis
and alcoholic cirrhosis. Am J Gastroenterol 1989;84:1231–4.
Gur A, Dikici B, Nas K, Bosnak M, Haspolat K, Sarac AJ.
Bone mineral density and cytokine levels during interferon
therapy in children with chronic hepatitis B: does interferon
therapy prevent from osteoporosis? BMC Gastroenterol
Schiefke I, Fach A, Wiedmann M, Aretin AV, Schenker E,
Borte G, et al. Reduced bone mineral density and altered
bone turnover markers in patients with non-cirrhotic chronic
hepatitis B or C infection. World J Gastroenterol
Isoniemi H, Appleberg J, Nilsson CG. Transdermal estrogen
therapy protects postomenopausal liver transplant women
from osteoporosis: A 2 year follow up study. J Hepatol
Gallego-Rojo FJ, Gonzalez-Calvin JL, Munoz-Torres M.
Bone mineral density, serum insulin like growth factor I, and
bone turnover markers in viral cirrhosis. Hepatology
Sokhi RP, Anantharaju A, Kondaveeti R, Creech SD, Islam
KK, Van Thiel DH. Bone mineral density among cirrhotic
patients awaiting liver transplantation. Liver Transpl
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.