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Bone Mineral Density, Bone Turnover, and Systemic Inflammation in Non-cirrhotics with Chronic Hepatitis C
Jennifer C Lai1, Dolores M Shoback, Jacob Zipperstein
1Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Box 0538, San Francisco, CA, 94143, USA, jennifer.lai@ucsf.edu.
Insights
Chronic hepatitis C (HCV) in non-cirrhotic patients is linked to low bone mineral density (BMD), not systemic inflammation. Elevated pro-peptide of type 1 collagen (P1NP) may signal bone risk.
Area of Science:
- Hepatology
- Endocrinology
- Bone Metabolism
Background:
- Chronic hepatitis C (HCV) is associated with systemic inflammation.
- The impact of chronic HCV on bone mineral density (BMD) independent of cirrhosis remains unclear.
Purpose of the Study:
- To investigate the relationship between BMD, systemic inflammation, and bone turnover markers in patients with chronic HCV without cirrhosis.
- To determine if chronic HCV infection affects bone health in the absence of advanced liver disease.
Main Methods:
- Sixty non-cirrhotic patients aged 40-60 with chronic HCV underwent BMD measurement via dual-energy X-ray absorptiometry.
- Serum markers of systemic inflammation (TNF-α, IL-6, CRP) and bone turnover (P1NP, BSAP, CTX, PTH) were analyzed.
- Statistical comparisons were made between patients with normal and low BMD.
Main Results:
- Low BMD (osteopenia or osteoporosis) was prevalent in 42% of participants.
- Elevated inflammatory markers (TNF-α, IL-6, CRP) were not significantly different between normal and low BMD groups.
- Patients with low BMD exhibited higher serum phosphorus and pro-peptide of type 1 collagen (P1NP) levels.
Conclusions:
- Low BMD is common in non-cirrhotic chronic HCV patients aged 40-60.
- Systemic inflammation markers did not correlate with BMD in this cohort.
- Elevated P1NP may identify individuals at higher risk for bone complications, suggesting chronic HCV is a risk factor for bone loss.
Background:
Whether chronic HCV, a disease characterized by systemic inflammation, impacts bone mineral density (BMD) independent of cirrhosis is unknown.
Aim:
We aimed to evaluate the association between BMD, systemic inflammation, and markers of bone turnover in chronic HCV without cirrhosis.
Methods:
Non-cirrhotics, 40-60 years old, with chronic HCV underwent measurement of: (1) BMD by dual-energy X-ray absorptiometry scan and (2) serum markers of systemic inflammation and bone turnover. By Chi-squared or t test, we compared those with normal versus low BMD.
Results:
Of the 60 non-cirrhotics, 53 % were female and 53 % Caucasian. Mean (SD) age was 53.3 years (5.7), total bilirubin 0.7 mg/dL (0.3), creatinine 0.8 mg/dL (0.2), and body mass index 28.4 kg/m(2) (6.5). Low BMD was observed in 42 %: 30 % had osteopenia, 12 % had osteoporosis. Elevated tumor necrosis factor α, interleukin-6, and C-reactive protein levels were found in 26, 32, and 5 %, respectively, but did not differ by BMD group (p > 0.05). Patients with low BMD had higher serum phosphorus (4.1 vs. 3.5 mg/dL) and pro-peptide of type 1 collagen (P1NP; 73.1 vs. 47.5 ng/mL) [p < 0.05], but similar bone-specific alkaline phosphatase, serum C-telopeptide, and parathyroid hormone levels.
Conclusions:
Low BMD is prevalent in 40- to 60-year-old non-cirrhotics with chronic HCV, but not associated with systemic inflammatory markers. Elevated P1NP levels may help to identify those at increased risk of bone complications in this population. Chronic HCV should be considered a risk factor for bone loss, prompting earlier BMD assessments in both men and women.
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