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FMC Chronic Liver Disease Clinical
Practice Consultant (CPC) Rosemary
McCormick and Chief Nuclear Medicine
Technologist Rebecca Hussey pictured
with a patient.
Vitamin D deficiency and low bone
density linked to liver disease
BY SARAH GARVIS
The largest study of bone disease in patients with cirrhosis has been completed at
Flinders Medical Centre (FMC), identifying a high prevalence of bone disease and
vitamin D deficiency in those with the liver condition.
developing slowly over many years, and may
eventually cause liver failure.
The liver carries out many essential functions,
including the filtration of toxins and waste
products from the blood, stores iron, helps
digestion, produces heat and makes and controls
cholesterol, hormones, sugars, antibodies, protein,
clotting factors and bile.
Ms McCormick said the information gained
through this study would help inform decision
making about the frequency and cost effectiveness
of bone disease screening for patients with
"If we have evidence to prove that patients with
cirrhosis have a higher risk of bone disease then
we may have a case for having the bone density
of these patients screened on a regular basis," she
"At present, bone mineral density screening is
performed every two years, along with monitoring
of Vitamin D levels.
"More regular bone density screening could lead
to earlier detection of osteopenia or osteoporosis
and a reduction in hospital admissions due to
broken bones and fractures.
"If bone density is below normal and/or Vitamin
D levels are low, we can encourage the patient to
start taking Vitamin D supplements."
The study, which examined a database of 333
patients with mixed severity and causes of the
disease, found that 56 per cent had low or
moderately low bone density (osteoporosis or
osteopenia) and/or Vitamin D deficiency.
Osteoporosis and osteopenia are conditions in
which bones become fragile and brittle leading to
a higher risk of fractures and breaks.
The study found those at highest risk of severely
low bone mineral density were those with a low
body mass index, a high Model for End-Stage Liver
Disease score (a scoring system for assessing the
severity of chronic liver disease), of an older age
FMC Chronic Liver Disease Clinical Practice
Consultant (CPC) Rosemary McCormick said
patients with cirrhosis were likely to have low bone
density and/or Vitamin D deficiency because of the
liver's role in producing Vitamin D.
"Vitamin D promotes calcium absorption in the gut
to enable the normal mineralisation of bone," she
"When the liver isn't functioning properly the
synthesis and absorption of Vitamin D is impaired."
Cirrhosis is a condition in which there is irreversible
scarring of the liver. The main causes are sustained
excessive alcohol consumption, viral hepatitis B and
C, and fatty liver disease. It is a progressive disease,
Ms McCormick said patients with cirrhosis under
the care of the Gastroenterology Unit were referred
to the hospital's Chronic Liver Disease Program,
which she runs with fellow Chronic Liver Disease
CPC Rachel Wundke.
The program, which is the only one of its kind in
Australia, provides patients with regular screening
and surveillance for the complications of cirrhosis,
including ultrasounds and an endoscopy to screen
for liver cancer and oesophageal varices (expanded
blood vessels) as well as a bone density scan to
check for osteoporosis and osteopenia.
"We also check immunity and offer vaccinations
for Hepatitis A and B," Rachel said.
"Patients with unstable severe liver disease receive
education and specialist nursing support in the
form of case management to assist them to better
manage their health in the community."
The program offers outreach clinics in the
community at GP Plus Health Care Centres in
Aldinga and Marion, and at the GP Plus Super
Clinic in Noarlunga.
"More regular bone
density screening could
lead to earlier detection
of osteopenia or
DR ROSEMARY MCCORMICK
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