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AIM:To determine the contributions of insulin-like growth factor 1 (IGF-1),cytokines and liver disease severity to bone mineral density in patients pre-transplantation.METHODS:Serum IGF-1,tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) were measured and the Model for End-Stage Liver Disease (MELD) score calculated in 121 adult patients referred to a single centre for liver transplantation.Bone mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray absorptiometry.Demographics,liver disease etiology,medication use and relevant biochemistry were recorded.RESULTS:A total of 117 subjects were included,with low BMD seen in 68.6%,irrespective of disease etiol-ogy.In multivariable analysis,low body mass index (BMI),increased bone turnover and low IGF-1 were independent predictors of low spinal bone density.At the hip,BMI,IGF-1 and vitamin D status were predictive.Despite prevalent elevations of TNFα and IL-6,levels did not correlate with degree of bone loss.The MELD score failed to predict low BMD in this pre-transplant population.CONCLUSION:Osteopenia/osteoporosis is common in advanced liver disease.Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.
AIM: To determine the contributions of insulin-like growth factor 1 (IGF-1), cytokines and liver disease severity to bone mineral density in patients pre-transplantation. METHODS: Serum IGF-1, tumor necrosis factor-a interleukin 6 (IL-6) were measured and the model for End-Stage Liver Disease (MELD) score calculated in 121 adult patients referred to a single center for liver transplantation. Bone mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray absorptiometry.Demographics, liver disease etiology, medication use and relevant biochemistry were recorded .RESULTS: A total of 117 subjects were included, with low BMD seen in 68.6%, irrespective of disease etiol-ogy.In multivariable analysis of low body mass index (BMI), increased bone turnover and low IGF-I were independent predictors of low spinal bone density. At the hip, BMI, IGF-I and vitamin D status were predictive. Despite prevalent elevations of TNFα and IL -6, levels did not correlate with degre e of bone loss. The MELD score failed to predict low BMD in this pre-transplant population. CONCLUSION: Osteopenia / osteoporosis is common in advanced liver disease. Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.