ECTS2013 Poster Presentations Osteoporosis: evaluation and imaging (31 abstracts)
Bone fragility in patients with alcoholic liver cirrhosis: can hip structure analysis better predict risk of hip fracture
Danijela Djonic 1 , Djordje Culafic 2 , Violeta Culafic-Vojinovic 3 , Svetlana Ignjatovic 4 , Ivan Soldatovic 5 , Jelena Vasic 3 & Marija Djuric 1
1Laboratory for Anthropology, School of Medicine, Institute of Anatomy, University of Belgrade, Belgrade, Serbia; 2School of Medicine, Clinic of Gastroenterology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia; 3Railway Health Care Institute, Belgrade, Serbia; 4Institute of Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia; 5School of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.
Hepatic osteodystrophy is an important complication of chronic liver disease associated with fractures resulting in pain, deformity and immobility. The aim of the study was to examine association of severity of alcoholic liver cirrhosis with areal bone mineral density (BMD) and to estimate bone geometric strength of the proximal femur in those patinets. The study included 27 male patients with alcoholic liver cirrhosis and control group of 36 healthy patients. Laboratory testing included biochemical markers of bone turnover: serum level of osteocalcin and β-cross laps. Areal BMD was measured by dual X-ray absorptiometry of the proximal femora. Structural parameters was obtained using the hip structure analysis software (HSA). Our findings of lower areal BMC and BMD, cross sectional area and section modulus, thinner cortex and higher buckling ratio in neck region of patients with cirrhosis suggest increased risk for fracture. Particular affection of cervical region is in agreement with general epidemiological data indicating more cervical than trochanteric fractures in elderly males. Decreased osteocalcin values and increased β-cross laps in patients with cirrhosis demonstrated predominantly low bone turnover caused by decreased bone formation with reduced synthesis of collagen matrix. This study confirms that the risk of fracture increases not only due to low bone density but also because of failure of skeletal geometry. This emphasizes the importance of more profound structural analysis of DXA scans in patients with cirrhosis than simple BMD and T scores.
Key words: Alcoholic liver cirrhosis, hepatic osteodystrophy, hip structure analysis, osteocalcin, β-cross laps.
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