Long-standing liver disease has long been recognized to result in fragile bones with increased risk of fractures. In various international studies, the overall incidence has varied from 11% to 48%, with a fracture rate of 3%-44%. However, the reason for this is poorly understood. With liver transplantation becoming a viable option in liver disease and offering complete cure and long-term survival, bone disease is becoming the major determinant of survival and quality of life in these patients.
A research article to be published on July 28, 2009 in the World Journal of Gastroenterology addresses this question. This research team was led by Tushar R Bandgar from KEM Hospital, India.
They found that low bone formation and increased resorption led to fragile bones in these patients. Contributing factors identified were inadequate sunlight exposure, reduced physical activity, low body weight, vitamin D deficiency and low level of testosterone. They also demonstrated that the severity of bone loss was accelerated in patients with low IGF-1 level. IGF-1 is normally synthesized in the liver and its synthesis is affected early in cirrhosis. The present study also found that the increased estrogen level seen in cirrhosis was protective against osteopenia.
These results shed new light on bone disorders seen in patients with cirrhosis. As most of the factors identified are correctable or treatable, it should provide additional help in treatment of these patients, such that they have better quality of life and survival.
Reference: George J, Ganesh HK, Acharya S, Bandgar TR, Shivane V, Karvat A, Bhatia SJ, Shah S, Menon PS, Shah N. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol 2009; 15(28): 3516-3522
Correspondence to: Tushar R Bandgar, MD, DM, Associate Professor, Department of Endocrinology, KEM Hospital, Parel, Mumbai 400012, India. firstname.lastname@example.org
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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