The relationship between bone mineral dencity and clinical and laboratory parameters ın nonalcoholic steatohepatitis.

IntroductionHepatic osteodystrophy is a common complication of chronic liver disease and its prevalence is between %13-70. Insulin like growth factor -1 (IGF-1) deficiency is one of the factors that play a role in the development of hepatic osteodystrophy. It is suggested that IGF-1 deficiency also has a role in the development of non-alcholic steatohepatitis (NASH). The aim of our study was to determine the relationship between NASH, bone mineral density and serum cytokin level.aterial and MethodA total of 38 patients with diagnosis of histologically proven NASH and 42 healthy controls were enrolled in the study in Dicle University Hospital between May 2010 and April 2011. Demographic features and clinical symptoms of both groups were recorded. Both NASH group and the control group were tested in terms of complete blood cell count and ruotine biochemical analysis as well as adrenale, thyroid and gonadal functions which can cause osteoporosis and steatohepatitis. Additionally, intact parathormone (iPTH), 25-OH-vitamin D3, tumor necrosis factor alfa (TNF-?), interleukin 6 (IL-6), interleukin-1 (IL-1), IGF-1, insuline like growth factor binding protein 3(IGFBP-3) level were tested in both group. Furthermore, lumber spine and femoral neck bone mineral density of both groups were measured by dual-energy x-ray absorptiometry (DEXA) method.ResultsThere were 25 men and 13 women and mean age was 41± 12 years in the NASH group. There were 25 women and 17 men and mean age was 43± 11 years in the control group. Mean weight (p=0.001), height (p=0.004), waist circumference (p=0.002) and male to women ratio (p=0.03) were significantly higher in the NASH group compared to control group. From laboratory parameters, serum glucose level (p=0.007), triglyceride (p=0.001), ALT (p<0.0001), AST (p<0.001), ALP (0.021), GGT (p<0.001) and ferritin level (p<0.001) were significantly higher in NASH group compared to control group. There was no significant difference between NASH and control group regarding serum TNF-?, IL-1, IL-6, IGF-1 and IGFBP-3 levels. Serum dihidroepiandrostenedion sulfat (DHEAS) (p=0.02), 25-OH-vitamin D3 (p=0.001) and testosteron levels (0,013) were significantly higher in the NASH group compared to control group. Lumber spine T score (p=0,004), and Z score (p=0.011) were significantly higher in the NASH group compared to control group. In the NASH group, there was no significant correlation between bone mineral density and fibrosis stage in liver biopsy.ConclusionWe found that NASH development increases bone mineral density and this increase may be related to elevated serum 25-OH-vitamin D3, DHEAS and testosterone levels.Key Words: Nonalcoholic Steatohepatitis, hepatic osteodystrophy, inflammatory cytokine, bone mineral density