Brief Article
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World J Hepatol. Nov 27, 2013; 5(11): 627-634
Published online Nov 27, 2013. doi: 10.4254/wjh.v5.i11.627
Increased bone mineral density in patients with non-alcoholic steatohepatitis
Muhsin Kaya, Devran Işık, Remzi Beştaş, Osman Evliyaoğlu, Veysi Akpolat, Hüseyin Büyükbayram, Mehmet Ali Kaplan
Muhsin Kaya, Remzi Beştaş, Department of Gastroenterology, Dicle University, School of Medicine, Diyarbakır 21100, Turkey
Devran Işık, Mehmet Ali Kaplan, Department of Internal Medicine, Dicle University, School of Medicine, Diyarbakır 21100, Turkey
Osman Evliyaoğlu, Department of Biochemistry, Dicle University, School of Medicine, Diyarbakır 21100, Turkey
Veysi Akpolat, Department of Biophysics, Dicle University, School of Medicine, Diyarbakır 21100, Turkey
Hüseyin Büyükbayram, Department of Pathology, Dicle University, School of Medicine, Diyarbakır 21100, Turkey
Author contributions: Kaya M designed the study, performed all liver biopsies and wrote the manuscript; Kaya M, Kaplan MA, Işık D, Beştaş R collected data; Evliyaoğlu O performed all biochemical analyses; Akpolat V measured bone mineral density; Büyükbayram H evaluated liver biopsy specimens; and Kaplan MA performed the statistical analysis.
Correspondence to: Muhsin Kaya, MD, Department of Gastroenterology, Dicle University, School of Medicine, Diyarbakır 21100, Turkey. muhsinkaya20@hotmail.com
Telephone: +90-412-2488001 Fax: +90-412-2488002
Received: July 20, 2013
Revised: September 25, 2013
Accepted: October 11, 2013
Published online: November 27, 2013
Processing time: 129 Days and 15.9 Hours
Abstract

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 study. Demographic features, clinical findings, complete blood count and routine biochemical analysis, as well as adrenal, thyroid and gonadal functions, were recorded. Additionally, intact parathormone, 25-OH-vitamin-D3, tumor necrosis factor-α, interleukin-6, interleukin-1, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were measured in both groups. Furthermore, lumbar spine and femoral neck BMD of both groups were measured by the dual-energy X-ray absorptiometry (DXA) method.

RESULTS: The mean age was 41 ± 12 years in the NASH group and 43 ± 11 years in the control group. Among 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-D3 levels (P < 0.0001) were significantly higher in the NASH group compared to the control group. Lumbar 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 biopsy.

CONCLUSION: NASH increases BMD and may be related to an elevated serum 25-OH-vitamin D3 level.

Keywords: Non-alcoholic steatohepatitis; Hepatic osteodystrophy; Bone mineral density

Core tip: Identifying the relationship between non-alcoholic steatohepatitis and bone mineral density (BMD) and its underlying mechanism is important. We found that patients with biopsy-proven non-alcoholic steatohepatitis (NASH) had higher lumbar BMD and serum 25-OH-vitamin-D3 levels compared to healthy controls. We did not find a significant relationship between serum levels of thyroid hormones, sex hormones, parathormone and cytokines, such as tumor necrosis factor-α, interleukin-1 (IL-1), IL-6, insulin-like growth factor-1, IGFBP-3 levels and BMD. An elevated serum 25-OH-vitamin D3 level may be the principle responsible factor in the increased bone mineral density in patients with NASH.