Different influence of the clinical condition, degree of cholestasis, alcohol abuse and serum calcium on the musculoskeletal system in chronic cirrhotics

SEBASTIAN EDUARDO FERRETTI; RICARDO FRANCISCO CAPOZZA; GUSTAVO ROBERTO COINTRY; SARA FELDMAN; MARÍA ROSA ULLA; HUGO TANNO; JOSÉ LUIS FERRETTI

Montreal (Canadá)

Congreso; XXX ANNUAL MEETING, American Society for Bone & Mineral Research (ASBMR; 2008

Different Influence of the Clinical Condition, Degree of Cholestasis, Alcohol Abuse and Serum Calcium on the Musculoskeletal System in Chronic Cirrhotics   S.E. Ferretti, R.F. Capozza, G.R. Cointry, S. Feldman, M.R. Ulla, H.E. Tanno, J.L. Ferretti Center of P-Ca Metabolism Studies (CEMFoC) and Service of Gastroenterology & Hepatology, Univ Hospital, Faculty of Medicine, Natl Univ of Rosario, Argentina.   This study analyzed the associations between indicators of the clinical condition (Child-Pugh Score -CPS, capturing bilirrubinemia, albuminemia, prothrombin time, ascitis and encephalopathy-), degree of cholestasis (total bilirrubinemia, plasma alkaline phosphatase -BRB, APase-), alcohol abuse, serum Ca and other biochemical variables, and tomographic (pQCT) indicators of bone mass (cortical CSA and BMC -CtA, CtC-, trabecular BMC and vBMD -TbC, vTbD-), cortical tissue mineralization (cortical vBMD -vCtD-), diaphyseal design (cross-sectional area moments of inertia -CSMI's-) and torsion strength (Stress-Strain Index -SSI-) and muscle mass (height-adjusted muscle CSA -mCSA-) of the radii (4% and 66% sites) and tibiae (4%, 14%, 38% & 66% sites) of 43 chronic cirrhotics (18 men) of alcoholic, viral, cryptogenetic, autoimmune or cholestatic etiology, aged 18-69 yr. Bone and muscle pQCT data were expressed as Z-scores calculated for every patient taking those of healthy men (60) and women (200) of comparable age as a control reference. The cirrhotic sample showed reduced TbC, vTbD and mCSA, while CtA, CtC, vCtD, CSMI’s and SSI were unaffected. The proportion between cortical bone mass (tibia + fibula CtA) and muscle CSA at the 66% site of the leg (calf) was reduced. Trabecular bone loss correlated with CPS (especially with its component, albuminemia) and with the degree of cholestasis only when alcohol abusers were excluded from the analyses. Muscle loss correlated with CPS but not with the degree of cholestasis. Alcohol abusers showed always these alterations, regardless of CPS and degree of cholestasis. Serum Ca did not correlate with any other indicator. No differences were detected in those analyses between forearm and leg pQCT data. The chronic cirrhosis condition reduced trabecular mass (and obviously the compressive strength of the trabecular network) in correlation with the severity of the disease and cholestasis, with little or no affectation of cortical mass, design, or strength. It reduced also correlatively muscle mass, regardless of the degree of cholestasis. However, the metabolic disturbance seemed to have reduced the impact of muscle-bone interactions in terms of bone mass (not material quality, design, or strength) related to muscle mass in the studied sample. The generally negative impact of alcohol abuse on all those properties was unrelated to any other influence.