Bone mineral density and biochemichal markers in children with chronic liver disease

ABSTRACT

Metabolic bone disease is known to complicate chronic liver disease. The aim of the present study was to determine bone mineral density [BMD] and bone turnover in children with chronic liver disease [CLD] and to assess the possible correlations with the severity of liver disease. Thirty hospitalized children with CLD,14 males and 16 females, aged 2-14 years and twenty age- and sex - matched healthy controls were enrolled. BMD was measured by dual energy X-ray absorptiometry at the lumber spines. Serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone [PTH], osteocalcin and carboxy- terminal telopeptide of type I collagen [ICTP] were measured. The severity of liver disease was assessed using Desmet's modification of Knodell's histological activity index. BMD was significantly lower in patients than in controls and osteoporosis was found in 8 [27%] of the patients. BMD was significantly correlated negatively with severity of liver disease and positively with serum osteocalcin level. No correlation was found between BMD and calcium, phosphorus? alkaline phosphatase, PTH, and ICTP serum levels. Serum osteocalcin level was significantly lower and serum ICTP was higher but not statistically significant in patients than in controls. Serum calcium, phosphorus, and PTH values in patients did not differ from those of controls. Levels of osteocalcin, but not PTH and ICTP9 were significantly correlated inversely with severity of liver disease. Ascitic patients had significantly lower BMD and serum osteocalcin values than non-ascitic patients, and also had significantly higher serum levels of ICTP than the controls. The results of this study indicate that BMD is decreased in children with CLD that is related to the severity of liver disease. The biomarkers of bone turnover reflect that decreased bone formation, rather than increased bone resorption, is the major contributor of bone loss in these patients