High serum osteoprotegerin and low RANKL in primary biliary cirrhosis

Background/Aims: Osteoprotegerin is decoy receptor for osteoclast activating factor, RANKL, and impairs osteoclast funtion. Since osteoporosis is common in primary biliary cirrhosis (PBC), we investigated osteoprotegerin, RANKL and markers of bone turnover in PBC. Methods: Serum osteoprotegerin, RANKL, osteocalcin (OC) and C-terminal cross-linking telopeptide of type I collagen (CTX-I) were measured by ELISA in 41 patients with PBC, 16 women with chronic hepatitis C (CHC), and as controls in 44 age-matched healthy and 74 post-menopausal osteopenic otherwise healthy women. Results: Serum osteoprotegerin levels were higher in PBC patients (7.8±3.0 pmol/l) than in healthy controls (4.4±2.3 pmol/l) and osteopenic women (4.0±1.0 pmol/l, P<0.0001 for both). RANKL levels were lower in PBC (0.9±1.8 pmol/l, P<0.0001) than in healthy controls (1.3±0.5 pmol/l). In CHC both osteoprotegerin (9.7±4.2 pmol/l) and RANKL (3.2±4.7 pmol/l) were elevated compared to the control groups (P<0.0001, for both). There was a positive correlation between serum osteoprotegerin and OC, CTX-I and AST but not with bone mineral density in PBC. Conclusions: The mechanisms and role of elevated osteoprotegerin and low RANKL in PBC are unclear, but it might partly represent a compensatory mechanism to negative balance of bone remodeling. High OPG and RANKL levels found in CHC might suggest that inflammatory process in the liver could also contribute to the elevation of osteoprotegerin.