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ISSN: 2641-1652

Current Trends in Gastroenterology and Hepatology

Research Article(ISSN: 2641-1652)

Is there a utility of Nordin’s Index in the evaluation of osteoporosis in patients with post viral cirrhosis? Results of a pilot study in Cameroonians Volume 3 - Issue 1

Mathurin Pierre Kowo1,2*, Raoul Rigobert Dim Bassi1, Jan René Nkeck1, Antonin Wilson Ndjitoyap Ndam3, Vicky Jocelyne Ama Moor1,2, Firmin Ankouane Andoulo1,4, Isabelle Dang Babagna Timba3 and Madeleine Singwé Ngandeu1,4

  • 1Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
  • 2University Hospital Centre, Yaoundé, Cameroon
  • 3Yaoundé General Hospital, Yaoundé, Cameroon
  • 4Yaoundé Central Hospital, Yaoundé, Cameroon

Received: November 11, 2020;   Published: December 17, 2020

*Corresponding author: Mathurin Pierre Kowo,Faculty of Medicine and Biomedical Sciences, University Hospital Centre,University of Yaoundé I, Cameroon

DOI: 10.32474/CTGH.2020.03.000155

 

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Abstract

Background: Metabolic bone disorders are frequent in patients with cirrhosis. These two conditions are usually misdiagnosed in Sub-Saharan Africa before the onset of complications. A full evaluation of metabolic bone disorders in patients with liver cirrhosis is difficult in our milieu and osteodensitometry is rarely available. In this preliminary study, we sought to determine the necessity of a cost-effective method, the Nordin’s Index, in the evaluation of osteoporosis in patients with liver cirrhosis.

Methods: This was a prospective cross-sectional study from January to May 2017 in Yaoundé. We compared the data of 19 patients (15 men, 4 women) with post viral liver cirrhosis and 17 controls (13 men, 4 women) paired with age, gender and body mass index (BMI). Data collected included vitamin D levels, serum and urine concentrations of calcium and phosphorus, Nordin’s Index and results of the bone mineral density using an x-ray absorptiometry scan. Statistical analysis was performed using the software SPSS 21. A p value of less than 0.05 was considered to be statistically significant.

Results: The mean age of patients was 38 ±15 years, with a mean BMI of 25 ±8 kg/m². Three of the four women were on menopause. Etiologies of cirrhosis were viral hepatitis B (8 patients), viral hepatitis B and D coinfection (7 patients), and viral hepatitis C (4 patients). The median duration of cirrhosis was 19 [8; 48] months, and 14 patients were classified grade A in Child Pugh classification. There was no statistical difference in the serum and urine concentrations of calcium and phosphorus. Osteoporosis was more frequent in cirrhosis (31.6% versus 11.8%, p<0.05). Nordin’s Index was significantly elevated in patients with cirrhosis compared to controls (0.12 [0.06; 0.13] mg/mg, versus 0.03 [0.01; 0.08] mg/mg, p<0.05), and in patients with cirrhosis associated to osteoporosis compared to those without (0.13 [0.09; 0.13] mg/mg versus 0.07 [0.03; 0.08] mg/mg, p<0.05). Vitamin D deficiency was more observed in controls (13/17 versus 7/19, p<0.05). Factors associated with osteoporosis were disease duration, elevated Nordin’s Index and elevated serum level of transaminases.

Conclusion: The Nordin’s Index, a simple and inexpensive tool for exploration of the phosphocalcic metabolism, could be useful for the evaluation of osteoporosis during viral cirrhosis. However, its performance has to be evaluated in a larger sample.

Keywords: Cirrhosis, chronic viral hepatitis, osteoporosis, Nordin’s Index, Vitamin D.

Abbreviations: ALAT: Alanine Aminotransferase; ALP: Alkaline Phosphate; ASAT: Aspartate Aminotransferase, BMD: Body Mass Density; GGT: Gamma Gluthamyl Transferase

Abstract| Introduction| Patients and Methods| Procedure| Results| Discussion| Conclusion| Declaration| Consent for publication| Availabilityof data and materials| Competing interest| Authors contribution| Acknowledgement| References|

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