Background Bone involvement is actually well demonstrated during chronic hepatopathies. Its frequency is not negligible and seems more frequent during auto-immune hepatopathies.
Objectives To study bone mineral density profile of patients suffering from chronic hepathopathies and to establish characteristics of osteoporotic patients.
Methods We carried a retrospective study from January 1996 to December 2009 including all cases of auto-immune hepatopathies [auto-immune hepatitis (AIH), primary biliary cirrhosis (PBC), Primary sclerosing cholangitis (PSC), Overlap syndrome PBC-AIH (OS1) and PSC-AIH (OS2)], diagnosed in the department of gastroenterology B in Rabta’s Hospital. We retained all patients having a bone densitometry (BD).
Results During the period of the study, 85 patients were included. Thirty one had a BD: 20 PBC, 2 AIH, 7 OS1, 1 PSC, 1 OS2. BD was normal in 8 cases (25%): 5 PBC and 3 OS1. Osteopenia was reported in 6 cases (19.3%): 4PBC, 1 AIH and 1 OS1. Seventeen patients had osteoporosis (54%): 11 PBC, 1 AIH, 3 OS1, 1 PSC and 1 OS2. The mean T-score was (-3.35 DS) on lumbar spine and (-1.93 DS) on femur. The mean Z score was (-2.1 DS) on lumbar spine and (-0.7 DS) on femur. The mean age of osteoporotic patients was 56,8 years (extreme: 38-76 years). There were 16 women (94%) and one man. Among women, 13 were already postmenopausal (81%). Research of risk factors of osteoporosis revealed a corticotherapy in all cases of OS1 and smoking in 1 case (9% CBP). Biological tests showed transaminase 2-fold above normal values, in 8 cases (47%) with gammaglutamyl transpeptidase ≥5-fold above normal values in 6 patients (35%). The mean rate of bilirubin was 58 mg/l. The immunological tests revealed the presence of anti-mitochondrion-antibodies in 11 cases (9 PBC and 2 OS1), antinuclear-antibodies in 3 cases (2 OS1 and 1 AIH) and anti-smooth-muscle antibodies in 3 cases (2 OS1 and 1 AIH). Associated autoimmune manifestations were observed in 10 cases. A fibrosis degree ≥2 (according to Metavir score) was noted in 10 cases of which 6 were at the stage of cirrhosis at the time of the diagnosis (37%).
Conclusions In our series, more than half of the patients with auto-immune liver diseases and having had a BD were osteoporotic. Bone loss is generally associated with PBC and is more frequent in postmenopausal women.
Disclosure of Interest None Declared