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Background: Liver Cirrhosis (LC) is associated with significant bone metabolic disorders and an increased risk of fractures. While the problem is recognized, data on vitamin D metabolism and bone remodeling in patients with non-alcoholic and non-viral LC remain limited.
Aim: To conduct a comprehensive assessment of vitamin D metabolism and bone remodeling in patients with LC of non-viral and non-alcoholic etiology.

Patients and methods: A cross-sectional study included 25 patients with LC (cholestatic, autoimmune, or cryptogenic etiology) and 10 Healthy Volunteers (HV), comparable in age, sex, and BMI. All participants underwent blood sampling for analysis of vitamin D metabolites, PTH, calcium, phosphorus, bone turnover markers and IGF-1. Bone Mineral Density (BMD) was assessed by DXA, and bone microarchitecture was evaluated using the Trabecular Bone Score (TBS).

Results: Patients with LC had significantly lower levels of 25(OH)D (12.5 vs., 22.4 ng/mL, p = 0.036), PTH (26.0 vs., 37.6 pg/mL, p = 0.015), and IGF-1 (95 vs., 187 ng/mL, p = 0.010) compared to the HV group. While BMD values were comparable between groups, the TBS was significantly lower in the LC group (1.348 vs., 1.504, p = 0.004), indicating impaired bone microarchitecture. A positive correlation was found between TBS and 25(OH)D levels (R = 0.497).

Conclusion: Young patients with non-alcoholic, non-viral LC exhibit vitamin D deficiency and a lower TBS despite preserved BMD. The correlation between TBS and vitamin D underscores its potential role in bone quality. These findings highlight the need for extended diagnostics, including TBS assessment, for timely fracture risk detection in this patient population.