FREQUENCY OF OSTEOPOROSIS IN PATIENTS WITH CIRRHOSIS DUE TO HEPATITIS B AND HEPATITIS C: A STUDY OF 100 CASES

Authors

  • Mohammad Javed
  • Arif Saeed
  • Ijaz Mohammad Khan
  • Khalid Hameed
  • Sher Rehman
  • Abbas Khan Khattak
  • Iqbal Ahmad
  • Shabir Ahmad Khan

Abstract

Background: 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

References

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)

http://www.ayubmed.edu.pk/JAMC/PAST/21-3/Javed.pdf 53

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

;7:181–5.

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

;14:337–41.

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.

Gastroenterology 1989;96:213–21.

Lindor KD. Management of osteopenia of liver disease with

special emphasis on primary biliary cirrhosis. Semin Liver

Dis 1993;13:367–73.

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

;5:30.

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

;11:1843–7.

Isoniemi H, Appleberg J, Nilsson CG. Transdermal estrogen

therapy protects postomenopausal liver transplant women

from osteoporosis: A 2 year follow up study. J Hepatol

;34:299–305.

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

;28:695–9.

Sokhi RP, Anantharaju A, Kondaveeti R, Creech SD, Islam

KK, Van Thiel DH. Bone mineral density among cirrhotic

patients awaiting liver transplantation. Liver Transpl

;10:648–53.

Published

2009-09-01

Issue

Vol. 21 No. 3 (2009): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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