Posthepatitik karaciger sirozlu hastalarda osteoporoz ve kemik metabolizmasi
Osteoporosis and bone metabolism in patients with posthepatitic liver circhosis
Özet
Giris ve amaç: Osteoporoz, özellikle alkolik ve kolestatik kronik karaciger hastalarinda uzun süreden beri tarif edilmektedir. Viral etiyolojili karaciger sirozunda osteoporoz ve kemik metabolizmasi ile ilgili çalismalar yetersizdir. Bu çalismada posthepatitik karaciger sirozlu hastalarda osteoporoz siddeti ve sikligi ile hastaligin evresi ile korelasyonunu saptamayi amaçladik. Gereç ve yöntem: Çalismaya posthepatitik karaciger sirozu tanisi konulan 39 hasta (25 erkek, 14 kadin, ortalama yas 52.3 ±11.2) ile ayni yas grubunda 24 saglikli kontrol olgusu (14 erkek, 10 kadin, ortalama yas 50.1±12.3) alindi. Hastalardan 12’si Child A, 13’ü Child B ve 14’ü Child C grubunda idi. Kemik mineral dansitesi dual enerji x-ray absorbsiyometrisi (DEXA) ile lomber vertebra ve femur boynunda ölçüldü. Kemik metabolizmasi ile ilgili biyokimyasal parametreler ve hormon düzeyleri arastirildi. Bulgular: Kemik mineral dansitesi lomber vertebrada karaciger sirozlu olgularda kontrol grubuna göre hem T hem de Z skoru açisindan anlamli olarak düsüktü (sirasiyla, p=0.001, p=0.001). Femur boynunda ise yalnizca T skoru açisindan anlamli düsüktü (p=0.046). Osteoporoz, lomber vertebrada T skoru açisindan %28.2, Z skoru için ise %17.9 bulundu. Hastaligin süresi ve Child evresi ile kemik mineral yogunlugu arasinda iliski yoktu. Albümin düzeyi ile lomber vertebra kemik mineral dansitesi, T skoru açisindan iliskili idi (p=0.09). Hastalarda osteokalsin ve parathormon düzeyi kontrol grubuna göre belirgin olarak düsüktü (sirasiyla p=0.001, p=0.027). Yine hastalarda idrar deoksipridinolin ve alkalen fosfataz düzeyi, kontrol grubuna göre belirgin olarak yüksekti (sirasiyla p=0.002, p<0.05). Sonuç: Viral etiyolojili karaciger sirozu osteoporozun önemli nedenlerinden birisidir. Hastaligin süresi ve child evresi ile kemik mineral dansitesi arasi nda iliski yoktu. Kronik karaciger hastaliginda osteoporoz tedavisi yararli olabilir.
Abstract
Background/aim: Osteoporosis has long been recognized in chronic liver disease, especially cholestatic or alcoholic liver diseases. Nevertheless, little is known about osteoporosis and bone metabolism in viral cirrhosis. The aim of the present study was to investigate the prevalance and severity of osteoporosis in cirrhotic patients and the correlation of the clinical severity of cirrhosis. Materials and methods: We studied 39 posthepatitic cirrhotic patient, (25 males, 14 females, mean age: 52.3±11.2) diagnosed both clinically and histopathologically and 24 healthy control subjects, showing similar age and sex characteristics (14 males, 10 females, mean age 50.1±12.3). 12 patients were in Child A, 13 were in Child B and 14 were in Child C stage. Bone mineral density (BMD) was measured by dual x-ray absorbtiometry in the lumbar spine and femoral neck. Bone metabolism markers and hormone profiles were measured. Results: The lomber bone mineral density was significantly lower in patients with viral cirrhosis than in controls for T and Z score (p=0.001, p=0.001, respectively). The femur neck mineral density was significantly lower only for T score (p=0.046). Osteoporosis prevalance in lumbar spine was 28.2% for T score and 17.9% for Z score, in cases with liver cirrhosis. No association was found between duration of disease and child staging with BMD values. The level of albumin was correlated with BMD values. The level of albumin was correlated with the lumbar spine mineral density for T score (p=0.09). Serum levels of osteocalcin and parathyroid hormone were significantly lower in patients with cirrhosis than in controls (p=0.001, p=0.027, respectively). In patients, urine deoxpyridinoline and serum alkaline phosphatase were significantly higher than in control subjects, (p=0.002, p<0.05, respectively). Conclusion: Our findings show that viral cirrhosis is a major cause of osteoporosis in patients. Bone mineral density did not correlate with the duration and Child classification of the disease. Treatment of osteoporosis in viral cirrhosis may be useful.
