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Hepatic osteodystrophy: An important matter for consideration in chronic liver disease

World Journal of Hepatology 2011年第12期3卷 300-307页

作者： Germán López-Larramona Alfredo J Lucendo Sonia González-Castillo José M Tenias Department of Internal Medicine Hospital General de Tomelloso 13700 Ciudad Real Spain Department of Gastroenterology Hospital General de Tomelloso 13700 Ciudad Real Spain Research Support Unit Complejo Hospitalario Mancha Centro Alcázar de San Juan 13700 Ciudad Real Spain

Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteo-penia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.

关键词： Hepatic osteodystrophy Liver disease Osteoporosis Osteopenia

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Hepatic osteodystrophy complicated with bone fracture in early infants with biliary atresia

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World Journal of Hepatology 2012年第10期4卷 284-287页

作者： Tadao Okada Shohei Honda Hisayuki Miyagi Masashi Minato Akinobu Taketomi Department of Pediatric Surgery Hokkaido University HospitalSapporo 060-8648Japan Department of Gastroenterological Surgery I Hokkaido University Graduate School of MedicineSapporo 060-8638Japan

Biliary atresia(BA) is one of the major hepatobiliary abnormalities in infants and one of the causes of hepatic *** disease may be caused by the malabsorption of calcium and magnesium by vitamin D in hepatobiliary diseases in which bile flow into the intestines is deficient or *** fracture before Kasai hepatic portoenterostomy or within one month after the procedure in an infant with BA is very *** herein report two infants:one infant with BA who initially presented with a bone fracture before Kasai hepatic portoenterostomy,and the other at 4 wk after Kasai hepatic portoenterostomy,and also provide a review of the ***,we conclude that clinicians should consider BA in infants with bone fracture during early infancy.

关键词： Biliary atresia Bone fractur Hepatic osteodystrophy Kasai hepatic portoenterostomy Vitamin Ddeficiency

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Renal osteodystrophy in Mullerian, Renal, Cervicothoracic Somite Abnormalities (MURCS Association): A Logical, However Hitherto Unknown Entity

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Open Journal of Radiology 2013年第2期3卷 99-102页

作者： Kishor Taori Jawahar Rathod Ramesh Parate Amit Disawal Suresh Dhakate Anand Hatgaonkar Amrita Guha Professor and Head Department of Radiodiagnosis Government Medical College Nagpur India

The MURCS association which stands for Mullerian, Renal, Cervicothoracic Somite Abnormalities is a rare developmental anomaly seen in females. The clinical course of this disorder is not clearly defined as of yet-which may range from asymptomatic to severe disability. Here we present the case of a young 22-year-old female who was incidentally detected to have a generalized increase in bone density with an absent uterus. Further workup revealed a case of MURCS association with renal osteodystrophy. This is an as of yet unreported complication/association and must be kept in mind in the treatment of these patients.

关键词： MURCS Association Renal osteodystrophy Absent Uterus

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Osteoporosis in primary biliary cholangitis

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World Journal of Gastroenterology 2018年第31期24卷 3513-3520页

作者： Christopher J Danford Hirsh D Trivedi Konstantinos Papamichael Elliot B Tapper Alan Bonder Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical CenterHarvard Medical School Department of Hepatology University of Michigan

Primary biliary cholangitis(PBC) is an autoimmune cholestatic liver disease with multiple debilitating complications. Osteoporosis is a common complication of PBC resulting in frequent fractures and leading to significant morbidity in this population, yet evidence for effective therapy is lacking. We sought to summarize our current understanding of the pathophysiology of osteoporosis in PBC, as well as current and emerging therapies in order to guide future research directions. A complete search with a comprehensive literature review was performed with studies from Pub Med, EMBASE, Web of Science, Cochrane database, and the Countway Library. Osteoporosis in PBC is driven primarily by decreased bone formation, which differs from the increased bone resorption seen in postmenopausal osteoporosis. Despite this fundamental difference, current treatment recommendations are based primarily on experience with postmenopausal osteoporosis. Trials specific to PBC-related osteoporosis are small and have not consistently demonstrated a benefit in this population. As it stands, prevention of osteoporosis in PBC relies on the mitigation of risk factors such as smoking and alcohol use, as well as encouraging a healthy diet and weight-bearing exercise. The primary medical intervention for the treatment of osteoporosis in PBC remains bisphosphonates though a benefit in terms of fracture reduction has never been shown. This review outlines what is known regarding the pathogenesis of bone disease in PBC and summarizes current and emerging therapies.

关键词： Biliary cirrhosis Cholestatic liver disease Osteopenia Hepatic osteodystrophy Bisphosphonates Hormone replacement therapy

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Vitamin D Deficiency and Its Relationship with Child-Pugh Class in Patients with Chronic Liver Disease

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Journal of Clinical and Translational Hepatology 2018年第2期6卷 135-140页

作者： Zubia Jamil Sharmin Arif Anum Khan Asghar Aurangzeb Durrani Nayyar Yaqoob Department of Medicine Foundation University Medical CollegeIslamabadPakistan Department of Medicine Fauji Foundation HospitalRawalpindiPakistan

Background and Aims:Skeletal manifestation in liver dis-eases represents the minimally scrutinized part of the disease *** D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver *** study aimed to investigate vitamin D levels and their relationship with disease advancement in these ***:Vitamin D levels were checked in 125 chronic liver disease *** patients were classified in three stages according to Child-Pugh score:A,B and *** relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency *** and logistic regression analyses were also carried out to find additional predictors of low vitamin D ***:Among the patients,88%had either insufficient or deficient stores of vitamin D,while only 12%had sufficient vitamin D levels(p>0.05).Vitamin D levels were notably related to Child-Pugh class(contingency coefficient=0.5,p<0.05).On univariate and multinomial regression analyses,age,female sex,MELD and Child-Pugh class were predictors of low vitamin D ***,model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels(p<0.05).Conclusions:Vitamin D deficiency is notably re-lated to age,female sex and model of end-stage liver disease score,in addition to Child-Pugh class of liver ***-min D levels should be routinely checked in patients with ad-vanced liver cirrhosis(Child-Pugh class B and C)and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.

关键词： Vitamin D deficiency Liver cirrhosis osteodystrophy Liver disease Skeletal manifestations

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MELD score,insulin-like growth factor 1 and cytokines on bone density in end-stage liver disease

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World Journal of Hepatology 2011年第6期3卷 157-163页

作者： Rebecca Mitchell Jill McDermid Mang M Ma Constance L Chik Divisions of Endocrinology and Metabolism Department of MedicineFaculty of Medicine and DentistryUniversity of AlbertaEdmontonAB T6G 2S2AlbertaCanada Division of Gastroenterology Department of MedicineFaculty of Medicine and DentistryUniversity of AlbertaEdmontonAB T6G 2S2AlbertaCanada

AIM:To determine the contributions of insulin-like growth factor 1 (IGF-1),cytokines and liver disease severity to bone mineral density in patients ***:Serum IGF-1,tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) were measured and the Model for End-Stage Liver Disease (MELD) score calculated in 121 adult patients referred to a single centre for liver *** mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray ***,liver disease etiology,medication use and relevant biochemistry were ***:A total of 117 subjects were included,with low BMD seen in 68.6%,irrespective of disease *** multivariable analysis,low body mass index (BMI),increased bone turnover and low IGF-1 were independent predictors of low spinal bone *** the hip,BMI,IGF-1 and vitamin D status were *** prevalent elevations of TNFα and IL-6,levels did not correlate with degree of bone *** MELD score failed to predict low BMD in this pre-transplant ***:Osteopenia/osteoporosis is common in advanced liver *** serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.

关键词： Hepatic osteodystrophy Insulin-like growth factor-1 Cytokines Bone mineral density MELD score

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Increased bone mineral density in patients with nonalcoholic steatohepatitis

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World Journal of Hepatology 2013年第11期5卷 627-634页

作者： Muhsin Kaya Devran Isik Remzi Bestas Osman Evliyaoglu Veysi Akpolat Hüseyin Büyükbayram Mehmet Ali Kaplan Department of Gastroenterology Dicle University School of Medicine Department of Internal Medicine Dicle University School of Medicine Department of Biochemistry Dicle University School of Medicine Department of Biophysics Dicle University School of Medicine Department of Pathology Dicle University School of Medicine

AIM:To determine the relationship between non-alcoholic steatohepatitis(NASH)and bone mineral density(BMD).METHODS:A total of 38 patients(25 males)with a diagnosis of histologically proven NASH and 42 healthy controls(24 males)were enrolled in the *** features,clinical findings,complete blood count and routine biochemical analysis,as well as adrenal,thyroid and gonadal functions,were ***,intact parathormone,25-OH-vitamin-D3,tumor necrosis factor-α,interleukin-6,interleukin-1,in-sulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were measured in both ***,lumbar spine and femoral neck BMD of both groups were measured by the dual-energy X-ray absorptiometry(DXA)***:The mean age was 41±12 years in the NASH group and 43±11 years in the control *** demographic features,waist circumference was significantly larger in the NASH group compared to the control group(P<0.019).Among laboratory parameters,serum triglyceride(P<0.008),alanine transaminase(P<0.0001),aspartate transaminase(P<0.001),alkaline phosphatase(P<0.016),gamma glutamyl transferase(P<0.0001),ferritin(P<0.001)and 25-OH-vitamin-D3levels(P<0.0001)were significantly higher in the NASH group compared to the control *** BMD was significantly higher in the NASH group compared to the control group(1.057±0.119 g/cm2vs 0.941±0.133 g/cm2;P<0.001,respectively).In the NASH group,there was no significant relationship between BMD and fibrosis stage in liver ***:NASH increases BMD and may be related to an elevated serum 25-OH-vitamin D3 level.

关键词： Non-alcoholic steatohepatitis Hepatic osteodystrophy Bone mineral density

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Clinical Study on Autosomal Dominant Polycystic Kidney Disease among South Indians

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International Journal of Clinical Medicine 2013年第4期4卷 200-204页

作者： P. Veeramuthumari W. Isabel PG & Research Department of Zoology & Biotechnology Lady Doak College Madurai India

Autosomal dominant polycystic kidney disease (ADPKD) is a commonly inherited disorder in humans, with a frequency of 1 in 100 in the general population. ADPKD is caused by mutations in PKD1 gene (85%) located on human chromosome 16p13.3;Mutations in the PKD2 gene contribute to 15% of ADPKD incidence and is located on human chromosome 4q2-23. A total of hundred ADPKD patients and age and sex matched healthy individuals were selected for the study. The study was aimed to evaluate the prevalence of ADPKD, lipid profile and level of calcium (Ca), sodium (Na), iron (Fe) and potassium (K) in patients with ADPKD and in healthy individuals. The lipid profile was analyzed using commercially available span kit and semiautoanalyzer (Erba, Chem 5X). The Ca, Na, Fe and K concentrations were estimated by flame photometry (ELICO, CL 22D) and atomic absorption spectroscopy (ELICO, SL 173) and significant changes were noted at p 0.05. The ADPKD patients were observed to have lipid abnormalities, hyponatremia, cholesterolemia, renal osteodystrophy, cardiovascular problems and anemia. Therefore, the study reveals an association between the lipid profile and Ca, Na, Fe and K levels with ADPKD among South Indian population.

关键词： Polycystic Kidney Disease Hyponatremia Renal osteodystrophy Anemia

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Hepatomusculoskeletal disorders:Coining a new term might improve the management of the musculoskeletal manifestations of chronic liver disease

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World Journal of Gastrointestinal Pathophysiology 2022年第4期13卷 124-127页

作者： Christos Tsagkaris Stavros P Papadakos Dimitrios V Moysidis Andreas S Papazoglou Alexandra Koutsogianni Marios Papadakis Public Health and Policy Working Group Stg European Student Think TankAmsterdamNetherlands Laiko General Hospital of Athens National and Kapodistrian University of AthensAthens 18233Greece Hippokration University Hospital Aristotle University of ThessalonikiThessaloniki 54642Greece Athens Naval Hospital Athens 18233Greece Department of Surgery II University Hospital Witten-HerdeckeUniversity of Witten-HerdeckeWuppertal 42283Germany

Chronic liver disease can affect many body systems including the musculoskeletal *** pathogenetic crosstalk between the liver and organs such as the brain and the kidneys has already been described with compound terms merging the organs affected by the pathology,such as the hepatorenal ***,the musculoskeletal manifestations of chronic liver disease have not been coined with such a term to *** of this shortage,documenting the musculoskeletal implications of chronic liver disease in both research and clinical practice is *** fill this gap,the authors propose the term hepatomusculoskeletal disorders,a compound term of Greek origin that encompasses all the body structures involved in the aforementioned pathologic crosstalk.

关键词： Chronic liver disease Hepatomusculoskeletal disorders Musculoskeletal system Hepatology Pathophysiology osteodystrophy

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New options for the management of hyperparathyroidism after renal transplantation

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World Journal of Transplantation 2012年第3期2卷 41-45页

作者： Walter Guillermo Douthat Carlos Raul Chiurchiu Pablo Ulises Massari Bone and Mineral Metabolism Section Renal Service Hospital Privado Centro Médico de Córdoba Postgraduate School of Nephrology Catholic University of Córdoba Fundación Nefrológica de Córdoba

The persistence and severity of hyperparathyroidism(HPT) post-renal transplantation is relatively frequent and primarily associated with the timing and its magnitude in the pre-transplant period and with the presence of parathyroid adenomas. HPT after renal transplantation is clinically manifested with hypercalcemia, hypophosphatemia, bone pain, fractures, and in more serious cases with cardiovascular calcifications that affect the survival. The primary clinical objective for patients with secondary HPT after renal transplantation is to obtain a level of parathyroid hormone(PTH) adequate to the renal transplanted function and to normalize levels of calcium, phosphorus and vitamin D. In many cases during this period, the development of hypercalcemiaand/or hypophosphatemia makes it necessary to take different therapeutic measures. The use of vitamin D or its analogues has been extrapolated from the management of pre-transplant HPT obtaining variable outcomes, although its use is limited by its capacity to produce hypercalcemia. Calcimimetics are drugs that have proven be effective in reducing PTH levels in patients with HPT on dialysis and has been effective in reducing up to 50% PTH levels in moderate to severe HPT in post-renal *** HPT persists after renal transplantation and does not respond to medical treatment, invasive management by percutaneous ethanol injection therapy of parathyroid glands or parathyroidectomy should be considered. The emergence of new methods for the management of HPT expands the availability of therapeutic tools for transplant patients.

关键词： Hyperparathyroidism Renal osteodystrophy Renal transplantation Percutaneous ethanol injection therapy Parathyroidectomy Percutaneous ethanol injection therapy

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