Bone Abstracts

Introduction: Osteoporosis is the musculoskeletal disease, the most common complication of liver osteodystrophy. Combined with vitamin D deficiency, they expose the patient to increased risk of fracture, increased morbidity and impaired quality of life.

The objective of the study is to evaluate the vitamin D status and the prevalence of densitometric osteoporosis in 100 patients followed for chronic liver diseases.

Materials and methods: Prospective study conducted between October 2014 and March 2015. This was a cohort of 100 patients followed for chronic liver disease, gastroenterology department at CHU Ibn Rochd of Casablanca. Were excluded patients with other pathology can induce a debilitating osteopathy (malabsorption syndrome, …). All patients benefited from an assessment of bone mineral density by densitometry (DEXA) and a calcium and phosphate (serum calcium, urinary calcium 24 h, serum phosphorus, phosphaturia 24 h, 25-OH Vitamin D). The desired outcomes were prevalence of vitamin D deficiency and bone loss and its risk factors.

Results: These were 100 patients. The average age was 53±16 years. The Sex ratio (M/F) was at 0.75. The average duration of evolution of liver disease was 29±31 mois. Thirty-five percent were followed for chronic viral hepatitis C, 31% post hepatitic cirrhosis, other causes were undetermined origin type of cirrhosis, chronic viral hepatitis B, primary biliary cirrhosis and autoimmune hepatitis. The average vitamin D was 18.24 ng/ml (SD 8.54), the mean serum calcium was 2.3 mmol/m, urinary 4.7 mmol/24 h Phosphoémie to 2.61 mg/l and urine to 16.03 mmol/24 h. 39% of patients had osteoporosis and 33% osteopenia. Among the raised risk factors, there was the low body mass index, the alcoholysis and smoking.

Discussion: The hypovitamin D is common in chronic liver diseases. It is involved in high prevalence of osteoporosis densitométrique. 12–45% depending on the series regardless of the etiology. In our study, bone loss was present in more than 2/3 of patients, regardless of the etiology of liver disease: 39–33% with osteoporosis and osteopenia. The therapeutic management involves systematically general measures including a balanced diet, alcohol and tobacco cessation and regular physical activity and specific treatment with a vitamin and calcium supplementation and bisphosphonates according to precise indications.

Conclusion: The vitamin D deficiency and bone densitometry loss are common in patients with chronic liver disease, cholestatic or not. Most often multifactorial, the vitamin and calcium assessment and ostéodensitométric must be systematic in all chronic liver disease monitoring balance sheet to prevent the occurrence of fractures, source of morbidity and mortality.