Bone mass in women with primary biliary cirrhosis: the relation with histological stage and use of glucocorticoids.

To assess the impact of primary biliary cirrhosis on bone mass in general and the relative importance of the stage of the liver disease and of treatment with glucocorticoids for the possible development of osteoporosis, bone mineral mass was measured by single and dual photon absorptiometry in 55 unselected female patients with longstanding primary biliary cirrhosis. Although most of the patients had a bone mineral density within the normal range, the bone mineral densities of the lumbar spine and distal and proximal forearm were 8% (P less than 0.004), 8% (P less than 0.03), and 5% (NS) respectively, lower than in age-matched healthy women. Multiple regression analysis showed that the histological stage of the liver disease (early stage vs. late stage) was an independent determinant of axial bone mineral density, whereas the use of glucocorticoids resulted in only a moderate and not significant bone loss. Serum calcium proved to be significantly lower in the patients with late-stage primary biliary cirrhosis than in those with early-stage disease, whereas no significant differences were found in these groups with regard to several biochemical parameters of bone metabolism. In conclusion, in patients with primary biliary cirrhosis, bone loss was only moderate and related to the histological stage. The effect of low-dose glucocorticoids on bone mass seemed not significant.

Noninvasive axial and peripheral assessment of bone mineral content: a comparison between osteoporotic women and normal subjects.

We compared different methods of bone densitometry in women with spinal osteoporosis and normal subjects to assess their discriminatory capability. The methods used included: quantitative computed tomography of the spine (QCT) specified as to trabecular (QCTtrab) and cortical bone (QCTcort), dual-photon absorptiometry of the spine (DPAspine), single-photon absorptiometry of the distal and proximal forearm (SPAdist and SPAprox), and quantitative roentgen microdensitometry of the phalanx (QMD). A total of 25 postmenopausal osteoporotic women and 24 healthy comparison subjects matched for age and years since menopause were studied. In the osteoporotic group an average decrement of the axial bone mineral density of -50% (p less than 0.001) and -20% (p less than 0.001) were observed for QCTtrab and QCTcort, respectively. For DPAspine, SPAdist, SPAprox, and QMD the difference between normal and osteoporotic subjects was -20% (p less than 0.001), -12% (p less than 0.05), -7% (NS), and -6% (NS), respectively. With the peripheral measurements (SPA and QMD), alone or in combination, no adequate discrimination between women with or without vertebral compression fractures could be obtained. Although QCTtrab showed the highest diagnostic sensitivity (81%), it appears not to be superior to DPAspine. Combinations of the various axial and peripheral measurements did not result in an essentially better sensitivity. In normal women as well as in osteoporotic individuals the trabecular and cortical QCT measurements showed two opposite trends, suggesting an increase in cortical and a decrease in trabecular density from L1 to L3.

Effects of 1 alpha-hydroxyvitamin D3 on various stages of predialysis renal bone disease.

Biochemical parameters of mineral metabolism and bone histomorphometric measurements--both static and dynamic--were studied in 27 to 29 patients with chronic renal failure before (T0) and after 3 months treatment (T3) with 1 alpha-hydroxyvitamin D3 (1 alpha (OH)D3; average daily dose 0.55 micrograms). In none of the biopsies was a positive aluminum stain found. Fourteen patients had an osteoblast seams length (Ob.Pm) of less than 4% (Group I) and high osteoid parameters, whereas 13 patients (Group II, Ob.Pm greater than 4%) also had clear histological signs of hyperparathyroidism. Group II had lower creatinine clearance and serum calcium, but higher iPTH values. Treatment with 1 alpha (OH)D3 resulted in a substantial suppression of secondary hyperparathyroidism in Group II, with a fall in Ob.Pm, the cancellous bone perimeter occupied by tetracycline double label and osteoclast perimeter (Oc.Pm). In Group II treatment resulted in the development of a positive correlation between Ob.Pm and the number of osteoclasts (N.Oc). With treatment the (thionine) mineralization front rose in both groups, but osteoid seams length did not fall. When calculated for both groups together, before and after treatment serum calcium was negatively correlated with osteoid seams length, while a positive correlation was found with the mineralization front. This study provides an indication that, in progressive renal bone disease in which aluminum intoxication has been excluded, hyperosteoidosis precedes the development of secondary hyperparathyroidism. Furthermore, the study shows that treatment with 1 alpha (OH)D3 suppresses secondary hyperparathyroidism and results in a moderate increase of mineralization.