Low bone mineral density and the severity of cholestasis in biliary atresia

Abstract

Aim: To investigate the prevalence of osteopenia and osteoporosis in postoperative biliary atresia (BA) children and the association of bone mineral density (BMD) and biochemical parameters in postKasai BA subjects.

Methods: A total of 70 patients with postKasai BA were enrolled in this prospective study. The patients were classified into two groups according to their jaundice status. BMD of the lumbar spine was analyzed using dual energy X-ray absorptiometry.

Results: The prevalence of low bone mass (osteopenia and osteoporosis) in BA patients were 51.4% (36 out of 70). Ten patients (35.7%) in the jaundice group and 8 patients (19.0%) in the non-jaundice group had osteopenia. Sixteen patients (57.1%) in the jaundice group and 2 patients (4.8%) in the no jaundice group had osteoporosis. In addition, lumbar spine BMD Z-score was substantially lower in the jaundice BA patients compared with non-jaundice patients. BA subjects with persistent jaundice had significantly lower serum 25-hydroxyvitamin D than those without jaundice. Further analysis revealed that lumbar spine BMD was correlated with age (r = 0.774, P < 0.001), serum albumin (r = 0.333, P = 0.005), total bilirubin (r = -0.476, P < 0.001), aspartate aminotransferase (r = -0.583, P < 0.001), alanine aminotransferase (r = -0.428, P < 0.001), and alkaline phosphatase(r = -0.456, P < 0.001).

Conclusion: Low BMD was associated with biochemical parameters reflecting the severity of cholestasis in postKasai BA patients.

Keywords: Biliary atresia; Bone mineral density; Cholestasis; Jaundice; Severity.

Figure 1

Scatter diagram and correlation analysis in biliary atresia patients. Lumbar spine bone mineral density are correlated with age (A), serum albumin (B), total bilirubin (C), aspartate aminotransferase (D), alanine aminotransferase (E), alkaline phosphatase (F).