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AIMS: Sclerostin is an endogenous inhibitor of the Wnt/ß-catenin pathway secreted by osteocytes, which inhibits osteoblast function, differentiation and survival. As a consequence, sclerostin tends to decrease bone mass. Alcoholics frequently present osteoporosis, mainly due to decreased bone synthesis. The behaviour of sclerostin in these patients is unknown. The aim of this work was to analyse the relationship between serum sclerostin levels and bone mineral density (BMD), ethanol consumption, nutritional status, liver function derangement and biomarkers of bone homeostasis in alcoholic patients. METHODS: We included 31 alcoholic patients, of whom 11 were infected with Hepatitis C virus (HCV) and 7 age and sex-matched controls. All underwent densitometry, and serum sclerostin, osteocalcin, collagen telopeptide, parathyroid hormone (PTH), vitamin D, cortisol and testosterone were determined. RESULTS: Sclerostin levels were significantly higher in patients (30.95 ± 18.91 pmol/l) than controls (t = 4.4; P < 0.001), especially in non-HCV patients; they showed an inverse correlation with osteocalcin, prothrombin activity and serum albumin, and a direct correlation with bilirubin and telopeptide, but not with BMD, nutritional status or ethanol intake. CONCLUSIONS: Serum sclerostin was raised in alcoholic patients, and it correlated with decreased markers of bone synthesis and increased markers of bone breakdown. The elevation in sclerostin levels was clearly related with liver function, but not with ethanol intake, nutritional status or concomitant HCV infection.

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Introducción. Si bien se conoce que la hepatopatía alcohólica se asocia a osteopatía, la presencia de esta y su intensidad han sido menos estudiadas en la hepatopatía por virus C. Material y métodos. Se incluyen 28 pacientes con infección por el virus de la hepatitis C (VHC) ingresados en el Servicio de Medicina Interna del Hospital Universitario de Canarias, determinándose marcadores bioquímicos de recambio óseo (cortisol, parathormona [PTH], 1,25 dihidroxivitamina D, factor de crecimiento insulínico [IGF]-1, osteocalcina), estado nutricional (por antropometría), masa grasa, masa magra y densidad mineral ósea (DMO) (por DEXA) y se compararon con un grupo control de similar edad. Resultados. Nuestros pacientes presentaban un descenso de la DMO en relación con los controles, especialmente manifiesto en los coinfectados por el virus de la inmunodeficiencia humana (VIH). Encontramos diferencias significativas de la DMO entre infectados y no infectados por VIH en lo que respecta a costilla derecha (T = 2,26, p = 0,037), columna lumbar (T = 2,45, p = 0,025) y pelvis (T = 2,23, p = 0,04). Se halló una relación significativa entre DMO en el brazo derecho y el perímetro braquial (p = 0,019), ocurriendo lo mismo entre masa magra determinada mediante DEXA en distintos niveles y DMO (masa magra total con DMO a nivel de brazo izquierdo [r = 0,69], a nivel del brazo derecho [r = 0,71], columna torácica [r = 0,79], lumbar [r = 0,53]. En lo que respecta a la actividad histológica, encontramos una relación significativa inversa entre masa ósea e índice de Knodell (relación entre DMO costilla derecha-Knodell p = 0,041; DMO columna lumbar-Knodell p = 0,033). Igualmente encontramos una relación inversa entre carga viral y masa ósea con valores del coeficiente de correlación oscilantes entre -0,52 y -0,48 (p < 0,05)....(AU)

Introduction. Although it is known that alcoholic liver disease is associated with bone disease, there are few studies that analyze bone alterations in chronic hepatitis C virus (HCV) infection. Material and methods. Twenty-eight consecutive patients affected by HCV infection admitted to the Internal Medicine Service of the Hospital Universitario de Canarias were included. Biochemical markers of bone turnover (cortisol, PTH, 1.25 dihydroxyvitamin D, IGF1, osteocalcin) were measured. Nutritional status was assessed by anthropometry, and fat mass, bone mineral density, and lean mass were all determined by densitometry (DEXA). These data were compared with those of a control group of similar age. Results. Our patients had decreased body mass (BMD) values compared to the controls, especially intense among HIV co-infected individuals. We found significant differences between HIV infected and not infected patients in relation to right rib (T = 2.26, p = 0.037), lumbar spine (T = 2.45, p = 0.025) and pelvis (T = 2.23, p = 0.04). There was a significant relation between BMD in the right arm and brachial perimeter (p = 0.019) and between lean mass at different levels and BMD (total lean mass at left arm r = 0.69, at right arm r = 0.71, thoracic spine r = 0.79, lumbar spine r = 0.53). We found a significant inverse relation between BMD and Knodell index (relation between BMD at right rib and Knodell, p = 0.041, and BMD at lumbar spine and Knodell index, p = 0.033). Conclusions. In patients with chronic HCV infection, there is a reduction of bone mass, particularly in HIV co-infected patients. This reduction is related to a reduction of the lean mass but not to fat mass, and maintains a relationship with viral load and histological activity(AU)

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