Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease
Version of Record online: 12 JAN 2002
Journal of Gastroenterology and Hepatology
Volume 16, Issue 9, pages 1022–1027, September 2001
How to Cite
Duarte, M. P., Farias, M. L. F., Coelho, H. S. M., Mendonça, L. M., Stabnov, L. M., Oliveira, M. D. C. D., Lamy, R. A. and Oliveira, D. S. (2001), Calcium-parathyroid hormone-vitamin D axis and metabolic bone disease in chronic viral liver disease. Journal of Gastroenterology and Hepatology, 16: 1022–1027. doi: 10.1046/j.1440-1746.2001.02561.x
- Issue online: 12 JAN 2002
- Version of Record online: 12 JAN 2002
- bone density;
- chronic hepatitis;
- liver cirrhosis;
- parathyroid hormone;
- vitamin D
Background: The main process involved in hepatic osteodystrophy seems to be osteoporosis, but decreased 25-hydroxylation of vitamin D might lead to osteomalacia and secondary hyperparathyroidism.
Methods and Results: We studied bone mineral density (BMD) by using DEXA-Expert Lunar, biochemical markers of bone turnover and calcium-parathyroid hormone (PTH)-vitamin D axis in 100 patients with chronic viral hepatitis secondary to hepatitis C virus: 49 non-cirrhotic (NCir) and 51 with cirrhosis (Cir) confirmed by liver biopsy and/or clinical and biochemical features. When compared to the age-matched population, 25% of the patients had low BMD at the lumbar spine (LS), 26.2% at Ward's triangle, 15.5% at the femoral neck (FN), and 20.2% at the trochanter. No difference was found either between Cir and NCir groups or between sexes. Urinary N-telopeptide was increased in 31.86% of the patients, and negatively correlated with BMD at the LS and trochanter (P < 0.02). Serum bone-specific alkaline phosphatase was elevated in 21% of the patients and negatively correlated with BMD at the trochanter and Ward's triangle (P < 0.02). Fasting 25-hydroxyvitamin D was low in only three Cir patients, with no difference between the Cir and NCir groups, but it was higher in men (51.8 ± 16.0 ng/mL) compared to women (40.4 ± 14.4 ng/mL; P = 0.001). Fasting serum calcium was lower in Cir than NCir patients, P = 0.019. Fasting intact PTH was elevated in 42% of the patients, but the mean serum levels were similar in Cir and NCir groups.
Conclusion: We found no evidence of vitamin D deficiency, but cannot exclude the participation of PTH in the high bone turnover and bone loss in the population with chronic viral hepatitis.