Abstract
Background and study aim: Hepatitis C virus infection is a multisystemic disease with many extrahepatic manifestations. Affection of bone matrix density is a common complication of chronic hepatitis and cirrhosis. The pathogenesis of osteoporosis in chronic liver disease is still unknown and is expected to be multifactorial. The aim of this work is to assess the frequency of osteoporosis/osteopenia in patients with chronic hepatitis C virus infection with or without cirrhosis. Patients and methods:This study was carried out on 30 patients with chronic HCV infection without cirrhosis (Group II), 30 patients with chronic HCV infection with compensated cirrhosis (Group III) and 20 age and gender matched healthy controls (Group I). All subjects of the study performed liver function tests, viral markers, liver biopsy, hormonal assay and Bone Mineral density measurement (BMD) by Dual energy X-ray absorptiometry (DEXA). Results : In patients with chronic hepatitis C (group II) the frequency of osteopenia was 11 (36.7%), osteoporosis 2 (6.7 %), total patients with low BMD was 13 (43.3%). In cirrhotic patients (group III), the frequency of osteopenia was 13 (43.3%), osteoporosis was 3 (10.0%), and total patients with low BMD was 16(53.3%) vs 1(5.0%) in the control group (group I). there was also no significant difference between patients with low BMD and patients with normal BMD as regards age, gender, common risk factors, liver function tests or hormonal levels. Conclusion : Reduced BMD is common chronic HCV-infected patients with and without cirrhosis. HCV infection is a risk factor of osteoporosis.
Highlights
Chronic hepatitis C (HCV) is systemic disease rather than hepatotropic and affects more than 170 million people worldwide [1]
All patients and control groups were subjected to: 1- Complete history taking with history of previous bone fractures. 2- History of drug therapy as steroids. 3- History of smoking and alcohol. 4- Thorough physical examination with special emphasizes on the manifestations of chronic liver disease. 5- Laboratory investigations including: - Complete blood picture. - Liver functions tests: liver enzymes, serum total proteins, albumin, serum bilirubin, alkaline phosphates, - Child- Pugh score - Abdominal ultrasonography. - HCV antibodies by ELISA. - HCV RNA by quantatitive PCR. - Serum calcium and phosphorus. - Hormonal assay: Hormonal immunoassasy: These included Parathyroid hormone level, Gonadal hormones levels (Testosterone and estrogen levels), Thyroid hormone (T3,T4, TSH)
The frequency of smoking and mean body mass index of each group were represented in Table 2 as common risk factors for osteoporosis with no significant differences found among the three studied groups
Summary
Chronic hepatitis C (HCV) is systemic disease rather than hepatotropic and affects more than 170 million people worldwide [1]. It ranges from 12 to 55% according to patient selection, diagnostic criteria, underlying liver disease and its severity [4,5]. Compensated as well as decompensated cirrhosis, whatever its cause, affects bone mineral density leading to osteopenia and osteoporosis [7]. Affection of bone matrix density is a common complication of chronic hepatitis and cirrhosis. The aim of this work is to assess the frequency of osteoporosis/osteopenia in patients with chronic hepatitis C virus infection with or without cirrhosis
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