Abstract
Background: Cirrhosis, a major and life-threatening complication of liver disease, has claimed over a million lives since 2010. It has been estimated that liver disease causes 1.03 million deaths/year globally. Chronic liver disease (CLD) affects metabolism of other organs such as the bone. The prevalence rates of hepatic osteodystrophy range from 13% to 70% in Western countries. Even higher prevalence rate between 68% and 95% has been reported from India. Reports from previous studies regarding the serum concentrations of 25(OH)D and its correlation with the progression of liver diseases have been inconsistent. Some studies have found that 25(OH)D levels decline as the liver disease progresses, whereas others found no significant difference between cirrhotic patients and non-cirrhotic patients or among the Child-Pugh groups. Vitamin D estimation is also thought to bear little predictive value to assess the progression of liver disease in etiologies such as hepatitis C. There are very few studies in the Eastern part of India to show the effect of CLD on bone mineral homeostasis. Based on this background, this study has been designed to reveal the effects of CLD and its severity on various parameters of bone mineral metabolism.

Aim and Objectives: The aim of the study was to evaluate the effects of different stages of CLD on bone mineral metabolism and its homeostasis.

Materials and Methods: After obtaining proper permission from the Institutional Ethics Committee, the cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine in a tertiary care hospital in Kolkata. The study included 90 cases with established CLD and 90 age- and sex-matched controls screened from the Department of Medicine. Serum Calcium, Inorganic phosphate, 25(OH) Vitamin D, and intact parathyroid hormone (iPTH) were estimated in the Department of Biochemistry. The Child-Pugh-Tucotte score was used to grade the severity of disease.

Results: It was observed that serum calcium and serum 25(OH) D levels were significantly lower in patients with CLD (P <0.0001). Serum iPTH levels were significantly higher in patients with CLD compared to controls (P < 0.0001).

Conclusion: Routine serial estimation of serum calcium, inorganic phosphate, and 25(OH)D should be mandatory in patients of CLD so that adequate replacements can be initiated as a therapeutic adjunct.

Key words: Child-Pugh Score; Hypocalcemia; Mineral Metabolism; Secondary Hyperparathyroidism; Severity of Liver Disease; Vitamin D Deficiency