THE RELATIONSHIP BETWEEN OSTEOPOROSIS AND FIBROSIS IN NAFLD PATIENTS
Low bone mineral density (BMD) is associated in patients with NAFLD, but the mechanisms behind the reduced BMD in NAFLD are still not completely known. Several factors may influence bone mineralisation such as : cytokines, vitamin D deficiency, limited physical activity. Aim of our study was to establish the relationship between osteoporosis and the degree of fibrosis in NAFLD patients estimated by transient elastography (TE) .
Methodes: We include 145 patients with NAFLD and we performed for all of them TE, abdominal ultrasonography and lumbar BMD was measured by DEXA. . The abdominal ultrasonography was performed by the same physician and steatosis was graded using a semi-quantitative scale of 1 (mild), 2(moderate) and 3 (severe).TE was ,also, performed by a single physician using conventional M probe or XL probe, with 10 valid acquisitions. We considered F0/F1-no/mild fibrosis, significant fibrosis (F2) when estimated cutoff of F2 was 7.1 kPa, severe fibrosis (F3) when cutoff value was 9.5 kPa, and cirrhosis (F4) with cutoff value ≥ 12.5 kPa. Blood samples were collected to determinate hepatic enzymes, lipid profile, glucose, albumin, platelet count, vitamin D level.
Results: We divided the patients into two groups: gr. A -97 patients with F0, F1 and gr. B-48 patients with F2, F3, F4. After we performed TE 66.9 % of patients had nosignificant fibrosis, 14.48% had F2, 9.65% had F3 and 8.97% had F4.The area under thereceiver-operating characteristic curve (AUROC) of TE was 0.823 (95%, 0.252- 0.394)(p <0.0001). Mean age was 46 ±13 years in gr. A and 52± 12 years in gr. B (p=0.012).No significant differences between the two groups in waist circumference, BMI, lipidprofile and the degree of steatosis. Vitamin D was significant lower in gr.B vs. gr. A(p<0.001). In gr. A we found 54 patients(55.6%) with normal T score, 23 withosteopenia and 20 (20.6%) with osteoporosis. In gr.B we found 18 patients (37.5%)with normal T score, 16 with osteopenia and 14 with osteoporosis(29%).
Conclusions: In our study osteopenia and osteoporosis are more frequent in NAFLD patients with high degree fibrosis and no dependent of steatosis degree. Vitamin D level correlated negatively with the degree of fibrosis.
Keywords: NAFLD, fibrosis, osteoporosis, vitamin D
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