Metabolic Bone Disease in Alcoholic Cirrhosis: A Comparison of the Effect of Vitamin D2 25-Hydroxyvitamin D, or Supportive Treatment

Authors

  • Sohrab A. Mobarhan,

    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
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  • Robert M. Russell,

    Corresponding author
    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
    • Robert M. Russell, M.D., Director of Human Studies, USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, Massachusetts 02111.
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  • Robert R. Recker,

    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
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  • David B. Posner,

    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
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  • Frank L. Iber,

    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
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  • Pamela Miller

    1. University of Illinois School of Medicine, Chicago, Illinois 60612; Veterans Administration Medical Center, Baltimore, Maryland 21218; USDA Human Nutrition Research Center on Aging at Tufts University, and Tufts University School of Medicine, Boston, Massachusetts 02111; Creighton University, Omaha, Nebraska 68131; University of Maryland School of Medicine, Baltimore, Maryland 21201
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Abstract

In a study of 56 alcoholics with liver cirrhosis, 18 (32%) had decreased bone density and low levels of serum 25-hydroxyvitamin D (25-OH-D) (<20 ng per ml). To compare the efficacy of vitamin D2 and 25-OH-D treatment in correcting the metabolic bone disease in alcoholic cirrhosis, the 18 patients were randomized in the following manner, in groups of six patients each: Group 1, control (received no supplemental vitamin D treatment); Group 2, given vitamin D2 (50,000 IU p.o.) two to three times weekly, and Group 3, treated with 25-OH-D (20 to 50 mg p.o.) daily as required to attain normal serum 25-OH-D levels. The study period lasted 6 to 12 months (mean, 10.7 months). Initial histomorphometric study of transiliac bone biopsy with double tetracycline labeling in nine patients in whom biopsy was feasible showed only osteoporosis without evidence of osteomalacia. By the end of the study, serum 25-OH-D levels in the control group (Group 1) raised slightly while showing marked improvement in Groups 2 and 3. Bone density results remained unchanged in control patients but demonstrated a significant increase in both treatment groups. Vitamin D2 and 25-OH-D were equally effective in increasing bone density measurements. Posttreatment biopsies were performed in three patients of Group 2 and two patients of Group 3. While the histomorphometric results in Group 3 were not conclusive, in Group 2 improvement in static measures of bone remodeling was noted. Osteoporosis is the usual form of bone disease in alcoholic cirrhosis and a response to either vitamin D2 or 25-OH-D treatment is suggested.

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