ORIGINAL ARTICLE J Bone Miner Metab (2008) 26:379–384 © Springer 2008 DOI 10.1007/s00774-007-0833-1 A. Mounach (*) · G. Wariaghli · L. Achemlal · A. Bezza · A. El Maghraoui Rheumatology and Physical Rehabilitation Department, Military Hospital Mohammed V, PO Box: 1018, Rabat, Morocco Tel. +212-3771-4419; Fax +212-3771-7032 e-mail: azizamounach@yahoo.fr Z. Ouzzif Biochemistry Department, Military Hospital Mohammed V, Rabat, Morocco I. Benbaghdadi Gastroenterology Department, Ibn Sina Hospital, Rabat, Morocco A. Aouragh Gastroenterology Department, Military Hospital Mohammed V, Rabat, Morocco Aziza Mounach · Zhor Ouzzif · Ghizlane Wariaghli Lahsen Achemlal · Imane Benbaghdadi · Aziz Aouragh Ahmed Bezza · Abdellah El Maghraoui Primary biliary cirrhosis and osteoporosis: a case-control study Abstract Osteoporosis is a common complication of chronic liver disease, from cholestatic disorders to autoimmune, alcoholic, and posthepatitic cirrhosis. Osteoporosis appears more striking in patients with primary biliary cirrhosis (PBC) because the disease usually affects elderly women, who are naturally prone to osteoporosis. Our aims were (1) to compare the prevalence of osteoporosis (T-score <-2.5 SD) between PBC patients and a group of age- and sex- matched controls consisting of healthy subjects from the general population; and (2) to identify the main risk factors for the development of bone loss. Thirty-three women with PBC (mean age, 47.3 ± 10.4 years) and 66 healthy subjects were enrolled in the study. Bone mineral density (BMD) was assessed at the lumbar spine by dual-photon X-ray absorptiometry. Bone metabolism was evaluated by mea- suring serum calcium corrected for serum albumin, 25- hydroxyvitamin D (25-OH vit D), parathyroid hormone, and osteocalcin. Vertebral fractures were analyzed using vertebral fracture assessment (VFA). The mean T-score was lower in the PBC group compared to healthy controls, with a significant statistical difference (-2.39 ± 0.93 and -1.47 ± 0.99 in lumbar spine and total hip, respectively, in the PBC group versus -0.99 ± 0.51 and -0.56 ± 1.14 in healthy controls (P < 0.001). The prevalence of osteoporosis was 51.5% in the PBC group versus 22.7% in healthy con- trols with a statistically significant difference (P = 0.004). BMD of the PBC group was significantly correlated posi- tively with body mass index (BMI) and 25-OH vit D, and negatively with menopausal status, duration of disease, and parathyroid hormone (PTH) levels. Vertebral fractures were present in 9% of the patients. We found that osteopo- rosis is more prevalent in women with PBC than in the general population. BMI, menopausal status, duration of the disease, and vitamin D deficiency are the main risk factors for osteoporosis in this liver disease. Key words primary biliary cirrhosis · bone mineral density · osteoporosis Introduction Primary biliary cirrhosis (PBC) is a presumed autoimmune disease of the liver, which predominantly affects women over the age of 20 years. It affects women nine times more often than men. Metabolic bone disease is a well-known complication of PBC. The etiology of this disorder is complex and multifactorial. The clinical spectrum of the PBC is very broad, ranging from asymptomatic patients to end-stage cirrhotic patients awaiting organ transplantation. Recently, it has become common to diagnose PBC in post- menopausal women with minor cholestasis. It has been suggested that untreated women with PBC lose bone mass at a rate approximately twice that seen in age-matched controls [1]. In contrast to what was believed earlier, histo- morphometric studies have shown unequivocally that osteo- porosis is the major disorder [2,3], which can result in spontaneous or low-trauma fracturing that significantly impacts morbidity, quality of life, and even survival. Overall, the reported mean prevalence of osteoporosis and vertebral fractures in most series is around 35% [4,5] and 3%–20%, respectively [6]. Disagreements concerning the abnormali- ties of bone remodeling and turnover that result in bone loss have emerged. Thus, an increased bone turnover has been found in some patients with PBC, and the rate of bone turnover increased as hepatic disease and cholestasis wors- ened [7]. Conversely, it has been suggested that levels of Received: May 12, 2007 / Accepted: December 2, 2007