Osteoporosis in men: A study in patients affected by chronic non-advanced liver disease

Background. Chronic liver disease has been shown to cause bone osteometabolic disease giving rise to osteoporosis and osteomalacia. Aim of this study was to evaluate bone mineral density (BMD) and bone metabolism markers in a selected series of male patients living in the same geographical area of Southern Italy, affected only by viral, non-advanced chronic liver disease, as compared to a randomly selected control group from the same geographical area. Patients ans Methods. Twentyfive male patients affected by biopsy-proven chronic hepatitis or liver cirrhosis only in Child's A class, virus-related, were selected in a one year period. Thirthy healthy male volunteers, living in the same geographical area, age, and BMI-matched, were examined as control group. Bone mineral density (BMD) was measured at lumbar spine (L1-L4) and at proximal femur of non dominant leg by Dual-Energy X-ray Absorptiometry (DEXA) using a Hologic QDR 1000 densitometer. Biochemical tests of liver function and bone metabolism in patients and controls were carried out after an overnight fast. Results. BMD was reduced in 16 (64%) out of 25 patients: 5 patients (20%) could be classified as osteoporotic and 11 patients (44%) osteopenic on the basis of at least one measurement. Mean BMD values for lumbar spine and femoral neck were significantly decreased in patients in comparison to the controls. Using multiple linear regression analysis, no correlation was found between BMD and the biochemical and functional variables studied. Our patients did not show any difference, as compared to controls, in bone remodelling markers as serum PTH, 25-OHD, calcium and sexual hormones, as well as urinary hydroxyproline. Conclusions. Our data, obtained on the basis of severe inclusion criteria, suggest that liver disease "per se" indipendently on its severity and lasting, can reduce the bone mass. Therefore more attention has to be paid to bone metabolism in liver patients.