Bone loss in autoimmune chronic active hepatitis on maintenance corticosteroid therapy

To determine the frequency of osteoporosis in patients with autoimmune chronic active hepatitis who are maintained on corticosteroids, both cortical and trabecular bone loss were studied in a group of 36 patients. A significant decrease in both the total trabecular bone volume (p = 0.005) and cortical plate thickness (p = 0.01) of iliac crest biopsy specimens was found in the patients with chronic active hepatitis. Bone mineral content of the radial metaphysis, a site composed of both cortical and trabecular bone, was found to be significantly decreased (p = 0.05). However, no statistical reduction in cortical bone mass of the radial diaphysis and second metacarpal was detected. Altogether, 47% of patients had evidence of either excessive trabecular or cortical bone loss, or both, as judged by histologic and radiologic criteria. The presence of cirrhosis at the time of diagnosis or subsequently did not appear to lead to greater loss of bone mass. However, a weak inverse correlation was found between the product of mean dose and duration of corticosteroid therapy and both the trabecular bone volume and the cortical plate thickness of the iliac crest biopsy specimens. Based on these results, patients with autoimmune chronic active hepatitis on low doses of prednisolone therapy may need to be treated with calcium and vitamin D at an early stage of their disease.