Reduced Serum Glucagon Like Peptide-1 In Children with Osteoporosis of Chronic Liver Diseases: A Single Center Trial

Abstract

Background: Chronic liver disease (CLD) in children is associated with reduction of bone mineral density. Glucagon like peptide- 1 (GLP-1) is essential for bone metabolism and bone turnover. GLP-1 role in bone disease associated with CLD remains to be studied.Aim of the work: to study the relationship between GLP- 1 and osteoporosis among children with CLD.Subjects and Methods: This cross-sectional study included 60 children with CLD as a study group and 60 healthy participants as a control group. GLP- 1 was measured using ELISA technique and compared between groups. All children with CLDunderwent liver biopsy and bone density dual-energy X-ray absorptiometry (DEXA) scan. The study was conducted at Benha University Hospital, Egypt.Results: The mean ± SD age of the included children with CLD and control group was 9.3 ± 5.1 years and 10.43 ± 5.54 years (p=0.130). Females and males comprised 33 (55%) and 27(45%) of the CLD group and 41 (68.3%) and 19 (31.7%) of the control group (p=0.133). The mean ± SD duration of liver diseases was 7.14 ± 4.51 years. Osteoporosis was encountered among 53 (88.3%) children with CLD. Their mean ± SD age was 9.51 ± 5.27 and their mean ± SD disease duration was 7.22 ± 4.65 compared to 7.71 ± 3.13 SD and 6.60 ± 3.52 SD of those who did not have osteoporosis (p=0.498) and (p=0.910) respectively. The mean± SD bone mineral density (BMD) and Z-score for lumber spine in children with CLD was 0.46 ± 0.14 g/cm2 and mean± SD Z- score was -2.7 ± 0.38. BMD correlated negatively with liver disease duration: r: -0.135, p=0.303, histological activity index: r: -0.101, p=0.441, fibrosis: r: -0.046, p= 0.726, PELD: r= -0.46; p= 0.003; MELD: r= -0.71; p< 0.001; CHILD Pugh: r= -0.26; p= 0.04). The mean ±SDserum GLP-1 among children with CLD was 3.06 ± 1.07 pg/ml and 6.5± 2.01 pg/ml in the control group (p= 0.001). Serum GLP-1 correlated negatively with progressive fibrosis (p=0.008). Serum GLP-1 correlated with BMD (p=0.013), and at a cut-off value of 4 pg/mL, GLP- 1 had 86.7% sensitivity and 83.3% specificity in diagnosis of osteoporosis in children with CLD. Serum 25(OH) vit D less than 28 nmol/L had a 100% sensitivity and specificity for detection of osteoporosis.Conclusion: DEXA confirmed osteoporosis of lumbar vertebrae among children with CLD. Serum GLP- 1 level was reduced among children with CLD. Serum GLP- 1 correlated inversely with degree of liver fibrosis and histological activity index and positively with the progression of osteoporosis in children with CLD. Low serum 25(OH) vit D is a sensitive and specific diagnostic marker of osteoporosis in CLD.