ASSESSMENT OF BONE MINERAL DENSITY AND VITAMIN D3 IN PATIENTS WITH CHRONIC LIVER DISEASE

Abstract

Introduction: Hepatic osteodystrophy is rather a common yet underdiagnosed entity. It leads to significant morbidity. Exact prevalence of hepatic osteodystrophy is not known but varies depending on etiology of chronic liver disease.

Aims: To measure bone mineral density by Dual Energy X-ray Absorptiometry (DEXA) scan, to measure level of serum 25(OH) vitamin D3 in patients with chronic liver disease and also to measure frequency of osteodystrophy in chronic liver disease.

Methodology: A cross sectional study on total fifty diagnosed patients with chronic liver disease (34 males within age 39.8±10.3 and 16 females within age 33.5±5.3) was done to determine frequency of hepatic osteodystrophy. Patients had undergone clinical and laboratory investigation for diagnosis of chronic liver disease and to exclude other comorbid conditions that may cause osteodystrophy. Severity of chronic liver disease was measured in terms of Child-Turcotte-Pugh (CTP) scoring. Each patient had undergone DEXA scanning to determine bone mineral density and also serum levels of 25(OH) vitamin D3 ,calcium and phosphate were measured. Patients with DEXA scan T score lower than -1 were diagnosed to have osteodystrophy.

Results: Out of 50 patients, 22 patients (44%) had alcoholic liver disease, 6 patients (12%) had chronic hepatitis B, 2 patients (4%) had autoimmune hepatitis and 20 patients (40%) had cryptogenic chronic liver disease. In our study 18 patients had osteopenia and 15 patients had osteoporosis. So out of 50 patients 33 patients had osteodystrophy and frequency of osteodystrophy in our study was 66%. Importantly severity of osteodystrophy had positive correlation with severity of chronic liver disease.

Conclusions: Hepatic osteodystrophy is a common complication of chronic liver disease and mostly asymptomatic. Severity of osteodystrophy increases with severity of chronic liver disease.