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This version published online on November 6, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0835
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Submitted on April 20, 2009
Accepted on September 17, 2009

Bone Mineral Density and Serum Levels of Soluble Tumor Necrosis Factors, Estradiol, and Osteoprotegerin in Postmenopausal Women with Cirrhosis after Viral Hepatitis

Jorge L. González-Calvin*, Jose L. Mundi, Francisco J. Casado-Caballero, Ana C. Abadia, and Jose J. Martin-Ibañez

Department of Gastroenterology (J.L.G.-C., J.L.M., F.J.C.-C., A.C.A., J.J.M.-I.), University Hospital San Cecilio, and Department of Biochemistry and Molecular Biology III and Immunology (A.C.A.), University of Granada, 18001 Granada Spain

* To whom correspondence should be addressed. E-mail: jgcalvin{at}ugr.es.

Context: Cirrhosis after viral hepatitis has been identified as a risk factor for osteoporosis in men. However, in postmenopausal women, most studies have evaluated the effect of primary biliary cirrhosis, but little is known about the effect of viral cirrhosis on bone mass [bone mineral density (BMD)] and bone metabolism.

Objective: Our objective was to assess the effect of viral cirrhosis on BMD and bone metabolism in postmenopausal women.

Design: We conducted a cross-sectional descriptive study.

Setting and Patients: We studied 84 postmenopausal female outpatients with viral cirrhosis and 96 healthy postmenopausal women from the general community. BMD was measured by dual-energy x-ray absorptiometry at lumbar spine (LS) and femoral neck (FN).

Results: The percentage with osteoporosis did not significantly differ between patients (LS, 43.1%; FN, 32.2%) and controls (LS, 41.2%; FN, 29.4%), and there was no difference in BMD (z-score) between groups. Serum concentrations of soluble TNF receptors, estradiol, and osteoprotegerin (OPG) were significantly higher in patients vs. controls (P < 0.001, P < 0.05, and P < 0.05, respectively). No significant difference was observed in urinary deoxypyridinoline. Serum OPG levels were positively correlated with soluble TNF receptors (r = 0.35; P < 0.02) and deoxypyridinoline (r = 0.37; P < 0.05).

Conclusions: This study shows that bone mass and bone resorption rates do not differ between postmenopausal women with viral cirrhosis and healthy postmenopausal controls and suggests that viral cirrhosis does not appear to increase the risk of osteoporosis in these women. High serum estradiol and OPG concentrations may contribute to preventing the bone loss associated with viral cirrhosis in postmenopausal women.







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