CLINICS 2010;65(10):971-974 CLINICAL SCIENCE DOI:10.1590/S1807-59322010001000008 Markers of autoimmune liver diseases in postmenopausal women with osteoporosis Umit Secil Demirdal,I Ihsan Hakkı Ciftci,II Vural KavuncuI I Department of Physical Medicine and Rehabilitation, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey. II Department of Microbiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey. INTRODUCTION: Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis. METHODS: One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X-ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti-liver/kidney microsomal autoantibodies1, liver-specific protein, anti- smooth muscle antibodies, and anti-mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases. RESULTS: The mean age of the patients was 63,13¡8,6 years. The mean values of L1-L4 T-scores and femur total T-scores were -3,08¡0,58 and -1,53¡0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti-liver/kidney microsomal autoantibodies1, and two (1.3%) were liver-specific protein positive. None of the patients had anti-mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range. CONCLUSIONS: The presence of liver membrane antibodies, liver-specific protein, and anti-liver/kidney microsomal autoantibodies1 has permitted us to see that there may be some suspicious clues of autoimmune liver diseases in patients with osteoporosis as a secondary risk factor. On the other hand, there is a need for comprehensive studies with a larger sample size and studies designed to compare the results with a normal population to understand the clinical importance of our findings. KEYWORDS: Osteoporosis; Autoimmune; Liver disease; liver autoantibodies; Aminotransferases. Demirdal US, Ciftci IH, Kavuncu V. Markers of autoimmune liver diseases in postmenopausal women with osteoporosis. Clinics. 2010;65(10):971-974. Received for publication on May 2, 2010; First review completed on May 25, 2010; Accepted for publication on July 13, 2010 E-mail: secilbabaoglu@yahoo.com Tel.: +90 272 246 33 33-3012 INTRODUCTION Osteoporosis (OP) is usually defined as a skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and increase in fracture risk.1 It affects up to one in two women and one in five men over the age of 50.2 It is a worldwide disease seen in all racial groups and in both males and females.3 In addition to being a common disease, OP becomes a serious health issue due to the increase in morbidity, mortality, and financial burden related with osteoporotic fractures.4-6 Osteoporosis can be classified as primary and secondary OP according to the underlying causes. Secondary OP may be described as the low mineral density in which an Copyright 2010 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. underlying cause or factor can be defined other than those attributable to the postmenopausal state or aging.7 Primary OP refers to OP when a secondary cause cannot be found.8 There are a number of secondary causes of osteoporosis such as hypogonadism or hyperparathyroidism, which are treatable, and renal failure, which should be considered more seriously. Chronic liver diseases also play an important role among secondary factors of OP.9,10 Bone disease is a major complication of chronic liver disease. OP is more commonly seen in patients with liver diseases as compared to the normal population, showing variable prevalence according to the patient selection and diagnostic criteria.11,12 OP is a common complication of chronic liver diseases such as cholestatic disorders, alcoholic liver diseases, posthepatitic cirrhosis, and autoimmune liver diseases (ALD).13 Types of ALD are autoimmune hepatitis (AH), primary biliary cirrhosis (PBC), and sclerosing cholangitis. ALD affects women at any age with a wide range of clinical presentations. In some cases, the disease is incidentally diagnosed during routine laboratory tests, while it shows a fulminate course in some others.14 971