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Title: Assessment of selected parameters of bone formation resorption and of bone mass in patients with chronic cholestasis

Jarosława Semianów-Wejchert, Krystyna Karachatzis, Anna Sidorowicz, Maria Jasińska, Leszek Paradowski
Original articles
Polish Gastroenterology
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Final page:
chronic cholestasis, hepatic osteodystrophy, calcium-phosphate balance, bone metabolism

Introduction: Disorders arising in the skeleton as consequence of chronic, mainly cholestatic liver diseases were defined as hepatic osteodystrophy. A reduction in bone mass (b.m.) and the change of the microar-chitecture of bone tissue are risk factors for fractures and their complications. The pathogenesis of hepatic osteodystrophy is complex and still not fully explained. Aims: Purpose of the study was to analyse clinical usefulness of selected indices of bone formation and resorption for informing about the dynamics and mechanism of bone mass loss in patients with chronic cholestasis, and to compare our own observations with the data presented in the literature that sometimes express contradictory opinions on the same subject. Material and methods: 18 patients aged 48.5± 12.9-yr with liver diseases coexisting with chronic cholestasis with mean duration of 4.5±1.5-yr were studied. In addition, 20 healthy volunteers at comparable age were exa-mined (control group). In all the studied subjects the routine laboratory blood examinations were carried out including, among others, the examination assessing the function of kidneys and liver, and the level of oste-ocalcin, bone alkaline phosphatase, acid phosphatase, total calcium and phosphorus. Furthermore, a 24--hour calciuria and phosphaturia as well as the bone mass of the calcaneal bone using "Achilles" ultrasonic densitometer were assessed. Results: In the studied patients with chronic cholastasis a significantly statistically higher concentration of oste-ocalcin in blood serum with reference to the value of this parameter in healthy subjects (8.42±4.98 vs. 3.50±2.23 ng/ml, p<0.001) and a decreased total calcium level (2.07±0.13 vs. 2.19±0.09 mmol/l, p<0.003) were found. The bone mass, defined as a stiffness index, was insignificantly statistically lower in patients with chronic cholestasis. In two of them the loss of bone mass corresponded to osteoporosis. Conclusions: Changes in the bone metabolism and calcium balance manifesting themselves by an increased osteocalcin level and by decreased concentration of total calcium were observed in the studied patients with chronic cholestasis. Osteocalcin is a more reliable marker of bone forming function than bone alkaline phosphatase in those patients. In some patients the loss of bone mass corresponded to osteoporosis. To as-sess the dynamics of processes occuring in the skeletal system a longer observation of patients with chronic cholestatic liver diseases is necessary.