CLINICS 2010;65(10):971-974 Two patients were found to have positive for both ANA and higher ALT levels, whereas three patients had higher ALT levels without autoantibodies positivity. AST and ALT levels were within normal range in patients with the other autoantibodies positivity. DISCUSSION In this study, we investigated the autoantibodies of ALD in patients with OP. Among the 150 patients with OP, 14 (9.3%) were ANA, four (2.7%) were LMA, three (2.0%) were anti-LKM1, and two (1.3%) were LSP positive. None of the patients had AMA or SMA positivity. The levels of amino- transferases of the patients with autoantibodies positivity were within normal range. Assessment of patients with OP is usually focused on the measurement of bone mineral density and investigation of bone metabolism markers. However, factors that affect the bone structure are various, and some should be kept in mind even if they have no place in routine laboratory evaluation. Dimutrescu et al. denote that 32% to 37% of women with low BMD have a history of other diseases or medications known to contribute to OP.20 Among women with OP, between 30% and 60% have a secondary cause.9 Liver diseases are one of the secondary causes investigated in a limited number of studies. In one study, 272 patients with OP, 96% of whom were women, were examined by laboratory evaluation for liver diseases in addition to endocrinologic disorders such as osteomalacia or hyperpar- athyroidism and hematologic diseases such as anemia. They mentioned that no unknown liver diseases were found in their study cohort.19 Melton et al. investigated secondary causes, including cirrhosis, in women and men with OP and osteopenia. Cirrhosis was not found in study cases, but one patient in the control group was found to have cirrhosis.21 Odabasi et al. found that three patients had chronic liver diseases among 947 postmenopausal women with OP when examined for secondary causes.8 Among the studies mentioned above, ALD or definite autoantibodies of ALD were not investigated. It is obvious that the diagnosis of ALD is not totally dependent on the presence of auto- antibodies; however, autoantibody positivity is the clue to the disease. In the view of this, the present study is a rare example of the studies investigating liver diseases in patients with OP. Among the 150 patients with OP, 14 (9.3%) were positive for ANA at 1:100 titers. ANAs were the first autoantibodies observed in AH and are still the most sensitive marker of the disease. On the other hand, ANA positivity is not specific for AH because positivity may occur in patients with other diseases and even in healthy subjects.22,23 The prevalence of ANA positivity is variable in the healthy population. In spite of the variability, the prevalence is age and sex dependant. Elderly over 60 years and females have relatively high frequencies of ANA. It is estimated that 10% to 15% of healthy people over the age of 65 are ANA positive, and the titers are usually # 1:160.23,24 Consistent with the literature, all our cohort were women, the mean age of the patients was 63,13¡8,6 years, and 9.3% of the patients were found ANA positivity for the 1:100 titers. Thereby, the age and sex of the cohort may be the causes of the highest prevalence of autoantibodies positivity for ANA. Tan et al. describe that there is no cut-off value that can reliably distinguish between normal and diseased populations. 973 Lıver autoantıbodıes ın patients with osteoporosis Demirdal US et al. However, it is considered that some healthy individuals have low-titer ANA.23-25 In the present study, it is accepted that 1:100 titers is enough for ANA positivity; the maximum titers of ANA was not studied. Therefore, this cut-off value was not enough to distinguish the pathologic value of ANA positivity of the cohort. The abnormal levels of liver function tests with ANA positivity may be useful for the association with AH. Only two patients were positive for ANA with ALT levels higher than upper limits. These patients had no history for signs or symptoms of any liver diseases. Therefore, clinical presentation of AH for the patients was not considered. Previous studies mention the diagnostic importance of LSP and LMA in ALD.15,26,27 In our study population, four (2.7%) patients were found to have positive for LMA and two (1.3%) for LSP. The biochemical assessments of the patients were within the normal range. The findings may be coincidental, but AH should be considered for patients when the elevated serum levels of aminotransferases are determined during the follow-up period. LMA were also found in some cases of alcoholic liver diseases,15 but one of the exclusion criteria of the study was alcohol use. Anti-LKM1 typically occurs in the absence of SMA and ANA in patients with AH.28 In accordance with this data, two patients were found to have with anti-LKM1 positivity in the absence of SMA and ANA positivity. In Europe, anti- LKM1 are found mainly in pediatric patients with AH and are demonstrated in only 20% of adults with the disease.28 The result that 2% of women without history of liver disease were found to positive for anti-LKM1 suggests that we follow up the patients after a period of time. The detection of AMA is nearly diagnostic of PBC, even in the absence of symptoms. AMA positivity with normal liver tests may be incidental and reflects a normal 0.5% incidence in the general population.29,30 Among the patients of the present study, AMA positivity was not detected. A possible explanation for the apparent difference between the result presented in this study and the number considered for the normal population (0.5%) may be the sample size. SMA facilitates diagnosis of AH and discriminates subtypes of the disease.22 No patients were found to have SMA positivity in the present study. Jamal et al. investigated the clinical utility of laboratory testing including serum aminotransferases to assess if an underlying medical condition is contributing to bone loss. They report that the prevalence of abnormal liver function tests in women with OP compared to women without was not different.31 Among the subjects included the present study, the mean levels of AST and ALT were within the normal range. Analyzing aminotransferases may be helpful to determine the abnormal laboratory tests findings condi- tional upon a diagnosis of liver diseases. On the other hand, this analysis has not permitted us to obtain any additional information because two patients were found to have positive for both ANA and higher ALT levels, whereas three patients had higher ALT levels without any auto- antibodies positivity. Our study has several limitations. First, the clinical importance of our findings seems debatable. The clinical importance can be discussed if it is possible to compare the prevalence of autoantibodies detected in the study popula- tion with the prevalence in age-matched postmenopausal women without OP. Unfortunately, the number of volun- teers without OP was not enough to constitute a control