Brief Article
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World J Hepatol. Jun 27, 2011; 3(6): 157-163
Published online Jun 27, 2011. doi: 10.4254/wjh.v3.i6.157
MELD score, insulin-like growth factor 1 and cytokines on bone density in end-stage liver disease
Rebecca Mitchell, Jill McDermid, Mang M Ma, Constance L Chik
Rebecca Mitchell, Constance L Chik, Divisions of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Alberta, Canada
Jill McDermid, Mang M Ma, Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Alberta, Canada
Author contributions: Mitchell M was involved in data collection, data interpretation, drafting of the manuscript and revision of the manuscript; McDermid J was involved in data collection, study conception, design and oversight, critical review and revision of the manuscript. Ma MM and Chik CL were involved in study conception, design and oversight, data interpretation, critical review and revision of the manuscript.
Supported by the Transplant Program of the University of Alberta Hospital
Correspondence to: Constance L Chik, MD, PhD, 362 HMRC, University of Alberta, Edmonton, AB T6G 2S2, Canada. cchik@ualberta.ca
Telephone: +1-780-4073636 Fax: +1-780-4076702
Received: November 30, 2010
Revised: May 20, 2011
Accepted: May 27, 2011
Published online: June 27, 2011
Abstract

AIM: To determine the contributions of insulin-like growth factor 1 (IGF-1), cytokines and liver disease severity to bone mineral density in patients pre-transplantation.

METHODS: 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 transplantation. Bone mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray absorptiometry. Demographics, liver disease etiology, medication use and relevant biochemistry were recorded.

RESULTS: A total of 117 subjects were included, with low BMD seen in 68.6%, irrespective of disease etiology. In multivariable analysis, low body mass index (BMI), increased bone turnover and low IGF-1 were independent predictors of low spinal bone density. At the hip, BMI, IGF-1 and vitamin D status were predictive. Despite prevalent elevations of TNFα and IL-6, levels did not correlate with degree of bone loss. The MELD score failed to predict low BMD in this pre-transplant population.

CONCLUSION: Osteopenia/osteoporosis is common in advanced liver disease. Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.

Keywords: Hepatic osteodystrophy; Insulin-like growth factor-1; Cytokines; Bone mineral density; MELD score