Nowadays there is a steady increase in the prevalence of osteoporotic changes among the Ukrainian population. At the same time, there is a steady tendency to increase the prevalence of the liver tissue pathology. The studies proved pathogenetic relationships between the progression of liver fibrosis and the severity of osteoporotic bone changes. There is evidence that therapeutic doses of vitamin D have antifibrotic effect. The purpose of the study was to determine the effect of standard therapy of steatohepatitis nonalcoholic genesis on bone mineral density values in patients, depending on the stage of liver fibrosis and to determine the effect of vitamin D therapy on the state of osteoporotic bone changes and on the state of fibrous hepatic tissue changes in such patients. Material and methods. We examined 69 patients with non-alcoholic steatohepatitis with an average age of 58.3 ± 6.25, 38 males and 31 females with no signs of other comorbid pathologies that had a possible effect on the development of secondary reduction of bone mineral density. All patients were assigned a level of 25OH of vitamin D. All examined women were in menopause. The mineral density of bones was examined in all patients on the bone marrow using an ultrasonic densitometer Sunlight mini omni according to the standard procedure adopted for this apparatus. For further analysis, the T level of the criterion, the level Z criterion was taken into account. All subjects were also evaluated for determining the degree of liver fibrosis using the method of flexural elastometry on the apparatus of Radmir ULTIMA RA EXPERT according to the standard methodology based on the methodological recommendations. Stages of fibrosis were displayed using the METAVIR scale. Results and discussion. All patients were prescribed standard therapy for steatohepatitis, namely: ursodeoxycholic acid in a daily dose of 15 mg/kg, divided into 3 doses, ademetionin 1 tab 1 time per day and artichoke extract 2 tablets 3 times a day for 6 months. All patients received calcium in the form of citrate and carbonate and half of the patients in each group received a vitamin D preparation at a dose of 1000 U /day. After 6 months, there was a repeated complex examination, which consisted of ultrasonic densitometry, and elastometry, as well as determination of the level of 25OH of vitamin D. It was determined that there was a high effect of vitamin D on the development of fibrous hepatic tissue changes and on the dynamics of osteoporosis in the examined patients. It was proved that standard therapy for steatohepatitis, even without the assignment of vitamin D, increases its plasma level and contributes to reducing fibrotic changes in the liver, while it contributes to increasing the mineral density of bones in these patients. Conclusions. It was concluded that it is necessary to determine the level of vitamin D in blood plasma for the purpose of early diagnosis of disorders of its circulation and the possibility of early correction of this condition in patients with fibrous hepatic tissue changes in the complex examination. The appointment of vitamin D drugs in a daily dose of 1000 UD for 6 months leads to a decrease in fibrous changes of the liver tissue, an increase of mineral density of bones according to ultrasonic densitometry.
Keywords: steatohepatitis, vitamin D, liver fіbrosis, osteoporosis
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