This paper concerns the history of two children with unusual liver pathology. The chief interest lies in the extensive bone changes that occurred in each instance. Although the primary etiology of the liver disorder in the two cases is obviously quite different, the changes in the skeletal system were similar in that extensive osteoporosis had taken place at some time during the course of the illness in both children. There is considerable information available as to the influence of the liver upon calcium and phosphorus metabolism; however, the explanation of the extensive osteoporosis occasionally observed in liver disease is not clear.
Pavlov1 demonstrated many years ago that dogs with biliary fistulas developed extensive osteoporosis. It was assumed that this condition resulted from the absence of bile salts, which promote vitamin D and calcium absorption. Seidel2 reported bone atrophy in two patients with bile fistulas of long duration. Tammann
Roberts MH, Sullivan C. INFLUENCE OF THE LIVER ON BONE METABOLISM: REPORT OF TWO CASES. JAMA. 1955;159(10):1002–1007. doi:10.1001/jama.1955.02960270022006
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