A stationary or portable infusion pump can be used to administer home parenteral nutrition (HPN). The stationary pump (SP) must be fasten to the infusion stand, so patients administer infusions in night mode to maintain their quality of life and mobility in the daytime. However, administering the HPN at nighttime can cause complications. Conversely, the portable pump (PP) does not have to be fasten to the infusion stand and the infusions can be administered in day mode during activities, as the PP can be placed in a special backpack. The aim of this diploma thesis is to evaluate the administration of HPN in day mode in patients with a PP and further to evaluate and compare the results of quality of life and liver function tests results in patients with a PP and a SP. HPN patients with a PP and a SP completed the HPN-QOL questionnaire in the nutritional clinic at the 4th internal clinic of the General University Hospital in Prague during outpatient visits. In addition to that, patients with a PP completed a questionnaire focused on the administration of HPN in day mode. Liver function tests results (total bilirubin, ALT, AST, GGT, ALP, cholinesterase and albumin) were obtained from patients' medical records. A total of 14 respondents with a PP and 14 respondents with a SP were included in the...

INTRODUÇÃO. A definição de insuficiência hepática pós-operatória (IHP) não é ainda padronizada, dificultando a comparação de inovações em procedimentos hepáticos e tornando complexo o uso de possíveis intervenções terapêuticas pós- operatórias em um momento adequado. CASUÍSTICA E MÉTODOS. Entre 1998 e 2002, 775 resecções hepáticas eletivas, dos quais 531 (69%) por doenças malignas e 464 (60%) consistindo em hepatectomias maiores, foram incluídas de maneira prospectiva em um banco de dados. O parênquima hepático não-tumoral foi anormal em 330 pacientes (43%) incluindo esteatose em mais que 30% dos hepatócitos em 107 (14%), fibrose sem cirrose em 237 (43%) e cirrose em 94 (12%). Foi analisado o impacto sobre a mortalidade da ocorrência de tempo de protrombina (TP) menor que 50% e bilirrubina total sérica (BT) maior que 50 µmol/L (3 mg/dl) (critério 50-50) nos dias pós-operatórios (PO) 1, 3, 5 e 7. RESULTADOS. A cinética pós-operatória do TP e da BT foram diferentes. O menor nível de TP foi no primeiro dia pós-operatório (PO) e o pico de BT foi no terceiro dia PO. A tendência ao retorno para valores pré-operatórios destes dois fatores bioquímicos se firmou claramente no quinto DPO. A mortalidade operatória global foi de 3.4% (26 pacientes), incluindo 21 (81%) casos com parênquima não-tumoral anormal e 20 (77%) após uma hepatectomia maior. O índice de mortalidade foi maior em pacientes com TP < 50% ou BT > 50 µmol/L (3 mg/dl) no pós-operatório. A conjunção de TP < 50% e BT > 50 µmol/L (3 mg/dl) no quinto DPO foi potente fator preditivo de mortalide, a qual atingiu 59% quando esta associação ocorreu. CONCLUSÕES. A partir do quinto dia PO, a associação de TP > 50% e BT > 50 µml/L (3 mg/dl) (critério 50-50) foi preditor prático e acurado de índice de mortalidade após hepatectomia. Propõe-se assim este critério como definição de insuficiência hepática pós-operatória. / INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis > 30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) < 50% and Serum Bilirubin (SB) > 50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT < 50% or SB > 50µmol/L (3mg/dl). The conjunction of PT < 50% and SB > 50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT > 50% and SB > 50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

INTRODUÇÃO. A definição de insuficiência hepática pós-operatória (IHP) não é ainda padronizada, dificultando a comparação de inovações em procedimentos hepáticos e tornando complexo o uso de possíveis intervenções terapêuticas pós- operatórias em um momento adequado. CASUÍSTICA E MÉTODOS. Entre 1998 e 2002, 775 resecções hepáticas eletivas, dos quais 531 (69%) por doenças malignas e 464 (60%) consistindo em hepatectomias maiores, foram incluídas de maneira prospectiva em um banco de dados. O parênquima hepático não-tumoral foi anormal em 330 pacientes (43%) incluindo esteatose em mais que 30% dos hepatócitos em 107 (14%), fibrose sem cirrose em 237 (43%) e cirrose em 94 (12%). Foi analisado o impacto sobre a mortalidade da ocorrência de tempo de protrombina (TP) menor que 50% e bilirrubina total sérica (BT) maior que 50 µmol/L (3 mg/dl) (critério 50-50) nos dias pós-operatórios (PO) 1, 3, 5 e 7. RESULTADOS. A cinética pós-operatória do TP e da BT foram diferentes. O menor nível de TP foi no primeiro dia pós-operatório (PO) e o pico de BT foi no terceiro dia PO. A tendência ao retorno para valores pré-operatórios destes dois fatores bioquímicos se firmou claramente no quinto DPO. A mortalidade operatória global foi de 3.4% (26 pacientes), incluindo 21 (81%) casos com parênquima não-tumoral anormal e 20 (77%) após uma hepatectomia maior. O índice de mortalidade foi maior em pacientes com TP < 50% ou BT > 50 µmol/L (3 mg/dl) no pós-operatório. A conjunção de TP < 50% e BT > 50 µmol/L (3 mg/dl) no quinto DPO foi potente fator preditivo de mortalide, a qual atingiu 59% quando esta associação ocorreu. CONCLUSÕES. A partir do quinto dia PO, a associação de TP > 50% e BT > 50 µml/L (3 mg/dl) (critério 50-50) foi preditor prático e acurado de índice de mortalidade após hepatectomia. Propõe-se assim este critério como definição de insuficiência hepática pós-operatória. / INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis > 30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) < 50% and Serum Bilirubin (SB) > 50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT < 50% or SB > 50µmol/L (3mg/dl). The conjunction of PT < 50% and SB > 50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT > 50% and SB > 50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

<p>Raloksifen je predstavnik selektivnih modulatora estrogenih receptora koji se koristi u terapiji osteoporoze i invazivnog oblika raka dojke u postmenopauzi. Raloksifen se relativno dobro resorbuje iz gastrointestinalnog trakta, ali pri prvom prolasku kroz jetru podleže biotransformaciji u značajnom procentu, &scaron;to je uzrok njegove niske biolo&scaron;ke raspoloživosti. Bioraspoloživost kod ljudi iznosi 2%, a kod Wistar pacova 39%. Različite supstance se koriste da bi se pobolj&scaron;ala bioraspoloživost lekova. Žučne kiseline, kao &scaron;to je deoksiholna kiselina, omogućavaju bolji prolazak kroz biolo&scaron;ke membrane drugim supstancama, te mogu povećati bioraspoloživost lekova. Apigenin je &scaron;iroko rasprostranjeni flavonoid koji inhibi&scaron;e različite metaboličke puteve i na taj način može usporiti metabolizam i eliminaciju i povećati koncentraciju lekova u krvi. Ciljevi ovog istraživanja su bili da se ispita da li apigenin i natrijum-deoksiholat mogu povećati bioraspoloživost raloksifena, njihov uticaj na biohemijske parametre i parametre hemostaze, kao i da se ispita antioksidativni potencijal apigenina. Ispitan je i uticaj apigenina na akutno o&scaron;tećenje jetre usled primene toksične doze paracetamola. U istraživanju su kori&scaron;ćeni zdravi, beli pacovi mu&scaron;kog roda, soja Wistar. U ogledu su ukupno kori&scaron;ćene 84 eksperimentalne životinje. Sva ispitivanja na životinjama je odobrila Etička komisija Univerziteta u Novom Sadu. Raloksifen je primenjen intravenski i per os, dok su natrijum-deoksiholat i apigenin aplikovani peroralno. Uzorci krvi, urina i fecesa su kori&scaron;ćeni za određivanje farmakokinetskih parametara, dok su za određivanje biohemijskih, hemostatskih i parametara oksidativnog stresa kori&scaron;ćeni serum i uzorci jetre laboratorijskih životinja. Pretretman natrijum-deoksiholatom je doveo do smanjenja koncentracije raloksifena u krvi zbog olak&scaron;anog i brzog prodora raloksifena u periferne kompartmane. Time je značajno produženo poluvreme eliminacije i srednje vreme zadržavanja raloksifena i značajno je povećan volumen distribucije raloksifena. Apigenin je doveo do manjeg pada koncentracije raloksifena u prvim satima nakon intravenske primene raloksifena, dok su koncentracije raloksifena bile značajno vi&scaron;e nakon osmog časa od primene leka. Uticaj raloksifena na biohemijske parametre je bio značajno veći nakon intravenske nego nakon peroralne primene. Nakon intravenske primene raloksifena je značajno povećana aktivnost enzima jetre, ALP, ALT, AST i GGT, dok su pokazatelji funkcije bubrega, urea, mokraćna kiselina i kreatinin bili sniženi. U grupama koje su pretretirane natrijum-deoksiholatom i apigeninom vrednosti ovih parametara bile su niže u odnosu na grupu tretiranu samo raloksifenom. Statistički najznačajniji uticaj je imala primena trojne kombinacije, raloksifena, natrijum-deosiholata i apigenina, koja je dovela do značajnog pada aktivnosti enzima jetre, i u odnosu na grupu tretiranu raloksifenom i u odnosu na kontrolnu grupu. Kod životinja tretiranih kombinacijom apigenina i paracetamola pokazatelji toksičnosti su bili značajno niži, naročito vrednosti ALT i ALP, u odnosu na grupu koja je dobijala samo paracetamol. Hepatotoksičnost izazvana toksičnom dozom paracetamola je potvrđena i histopatolo&scaron;kim promenama na jetri, koje nisu primećene u grupi životinja tretiranih kombinacijom apigenina i paracetamola. Ispitivanjem je utvrđeno da apigenin može da spreči paracetamolom indukovano povećanje nivoa MDA, &scaron;to ukazuje da apigenin pozitivno utiče na očuvanje integriteta ćelije. Aktivnost enzima CAT i GR u homogenatima jetre je bila značajno povećana nakon primene toksične doze paracetamola u odnosu na kontrolnu grupu. Aktivnost enzima CAT i GR u grupi tretiranoj kombinacijom apigenina i paracetamola je bila približna vrednostima u kontrolnoj grupi. Na osnovu rezultata istraživanja može se zaključiti da natrijum-deoksiholat i apigenin značajno utiču na farmakokinetiku raloksifena. Primena natrijum-deoksiholata dovela je do pada koncentracije raloksifena u krvi, značajnog prelaska raloksifena iz krvi u periferne kompartmane i povećanja njegovog volumena distribucije, dok je apigenin značajno usporio metabolizam i eliminaciju raloksifena i doveo do njegovog produženog zadržavanja u krvi. Natrijum-deoksiholat i apigenin su pokazali pozitivan uticaj na biohemijske parametre, parametre hemostaze i smanjenje nivoa oksidativnog stresa. Kombinacija natrijum-deoksiholata i apigenina je pokazala sinergistički uticaj na navedene parametre, odnosno dovela je do značajnih promena u odnosu na pojedinačnu primenu ovih supstanci. Rezultati ispitivanja ukazuju na to da apigenin smanjuje stepen lipidne peroksidacije i da dovodi do značajnog povećanja enzimskih antioksidantnih mehanizama odbrane kod pacova kod kojih je hepatotoksičnost indukovana paracetamolom.</p> / <p>Raloxifene is selective estrogen receptor modulator used in treatment of osteoporosis and invasive breast cancer in postmenopausal women. Raloxifene is well absorbed from the gastrointestinal tract, but undergoes extensive first-pass metabolism, which results in very low bioavailability of raloxifene, 2% in humans, and 39% in Wistar rats. Various supstances are used for increasing bioavailability of other drugs. Bile acids, such as deoxycholic acid, promote transport of other supstances through biological membranes, and consequently, may increase their bioavailability. Apigenin is a widespread flavonoid, which inhibits different metabolic pathways. Thus, apigenin can slow down metabolism and elimination of drugs, and raise drug concentration in blood. Aims of this study were to investigate if apigenin and sodium deoxycholate could increase bioavailability of raloxifene, their influence on biochemical and hemostasis parameters, and to investigate antioxidative potential of apigenin. Furthermore, influence of apigenin on acute liver damage after toxic dose of paracetamol was examined. In vivo experiments were performed on 84 laboratory healthy male Wistar rats. All experiments were approved by Ethics Committee of University of Novi Sad. Raloxifene was applied intravenously and per os, while sodium deoxycholate and apigenin were given perorally. Blood, urine and feces samples were used for pharmacokinetic parameters measurement, whereas serum and liver samples were used for evaluation of biochemical, hemostasis and oxidative stress parameters. Pretreatment of sodium deoxycholate led to raloxifene blood concentration decrease due to easier penetration of raloxifene in peripher compartments. As a result, raloxifene half-life and mean residence time were significantly longer and volume of distribution was increased. Apigenin caused lower decrease in raloxifene concentration in first few hours after raloxifene intravenous application, while raloxifene concentrations after apigenin pretreatment were significantlny higher 8 hours after raloxifene application. Influence of raloxifene on biochemical parameters was more significant after intravenous than after per os application. Intravenous application of raloxifene led to increased activity of liver enzymes, ALP, ALT, AST and GGT, while parameters of kidney function, urea, uric acid and creatinine were decreased in comparison to the control group. In experimental groups pretreated with sodium deoxycholate and apigenin these parameters were lower than in the group treated only with raloxifene. Statistically the most significant effects were in the group treated with combination of raloxifene, sodium deoxycholate and apigenin, which caused significant decrease in activity of liver enzymes compared both with raloxifene and control group of animals. In experimental animals treated with combination of apigenin and paracetamol bioindicators of paracetamol toxicity were significantly lower, especially activity of ALT and ALP, in comparison to the group treated only with paracetamol. Hepatotoxicity induced by toxic dose of paracetamol was also confirmed by histopathological alterations in liver, which were not observed in the experimental group treated with combination of apigenin and paracetamol. In this study it was confirmed that apigenin could prevent paracetamol-induced MDA level increase, which suggests that apigenin have positive effects on cell integrity. Activity of CAT and GR in liver homogenates was significantly increased after toxic dose of paracetamol in comparison to the control group, while activity of these enzymes in the group treated with apigenin and paracetamol was similar to values in the control group. Results of this study showed that sodium deoxycholate and apigenin can significantly change pharmacokinetic parameters of raloxifene. Sodium deoxycholate caused signicant decrease in raloxifene blood concentration, extensive distribution from blood to peripheral compartments and increase of raloxifene volume of distribution. Apigenin inhibited metabolism and elimination of raloxifene and thus prolonged half-life and mean residence time of raloxifene. Sodium deoxycholate and apigenin showed positive effects on biochemical and hemostasis parameters and decreased the level oxidative stress. Combination of sodium deoxycholate and apigenin showed synergistic effects on these parameters in comparison to effects of separate application of sodium deoxycholate and apigenin. The result of our study indicates that apigenin inhibits the level of lipid peroxidation and significantly increase the enzyme antioxidant defence mehanisms in paracetamol induced hepatotoxicity in rats.</p>

<p>Uvod: Hepatička osteodistrofija je termin koji obuhvata metaboličke bolesti kosti udružene sa hroničnim bolestima jetre. U alkoholnoj cirozi (AC) jetre postoji visoka zastupljenost deficijencije vitamina D proporcionalna stepenu disfunkcije jetre, ali njena uloga u patogenezi hepatičke osteodistrofije nije dovoljno obja&scaron;njena. Nivo 25(OH)D odražava status vitamina D. Kod AC jetre izmenjena je metabolička aktivnost kosti i suprimirano je formiranje kosti &scaron;to dovodi do smanjenja ko&scaron;tane mase. U centru interesovanja je postizanje optimalnog statusa vitamina D. Stavovi o suplementaciji vitaminom D kod AC jetre nisu jasno definisani. Cilj rada: Utvrditi nivo vitamina D, ispitati metaboličku aktivnost kosti i mineralnu gustinu kosti kod bolesnika sa AC jetre. Utvrditi efekte suplementacije sa 1000 IU vitamina D3 na dan tokom godinu dana u odnosu na metaboličku aktivnost kosti i mineralnu gustinu kosti kod ispitivanih bolesnika. Bolesnici i metode: Istraživanje je sprovedeno na Klinici za gastroenterologiju i hepatologiju Kliničkog centra Vojvodine u Novom Sadu kao prospektivna intervencijska studija sa primenom suplementacije sa 1000 IU vitamina D3 na dan kod bolesnika sa AC jetre. Grupu bolesnika koja je uključena u istraživanje (1) činilo je 70 bolesnika mu&scaron;kog pola sa dijagnozom AC jetre. Bolesnici su imali četiri pregleda (P), odnosno tačke studije: P1-uključivanje bolesnika i započinjanje suplementacije vitaminom D; P2, P3 i P4 posle tri, &scaron;est i dvanaest meseci suplementacije vitaminom D, redom. Prilikom svakog pregleda rađene su analize funkcije jetre, metabolizma kosti i statusa vitamina D. Na početku (P1) i na kraju istraživanja (P4) vr&scaron;eno je merenje mineralne gustine kosti (BMD) DXA metodom. Gubitak bolesnika od P1 do P4 bio je dvadeset, na različitim tačkama studije. Prvi deo istraživanja odnosi se na Grupu bolesnika koja je uključena u istraživanje (1) i zavr&scaron;ila prvi pregled (P1). Pedeset bolesnika je zavr&scaron;ilo kompletno istraživanje po predviđenom protokolu i oni se zbog realizacije svih pregleda i ponovljenih merenja posmatraju kao: Grupa bolesnika koja je zavr&scaron;ila istraživanje (2). Rezultati: (1): Kod bolesnika sa AC jetre utvrđena je deficijencija vitamina D, snižen nivo osteokalcina, normalni nivoi CrossLapsa, PTH, ukupnog i jonizovanog kalcijuma, fosfora i magnezijuma. Osteopeniju je imalo 42,65% a osteoporozu 14,71% ispitanika. Kod svih ispitanika najniži BMD izmeren je na vratu femura. (2): Suplementacija vitaminom D dovela je do značajnog porasta 25(OH)D. U odnosu na osteokalcin konstatovana je pozitivna razlika vrednosti P1/P4, iako je nivo ostao ispod donje granice normale. Kod nivoa CrossLapsa i PTH razlika P1/P4 je negativna, ali su nivoi u sva četiri merenja u okviru referentnih vrednosti. Na lumbalnoj kičmi do&scaron;lo je do pobolj&scaron;anja BMD za 0.87%, a pogor&scaron;anja su na vratu femura -1.87 % i kuku -1.65%. Konstatovano je i pobolj&scaron;anje funkcije jetre. Zaključci: Kod bolesnika sa AC jetre pobolj&scaron;anje statusa vitamina D dovodi do povećanja formiranja kosti i pobolj&scaron;anja ko&scaron;tane mase na lumbalnoj kičmi. Neophodno je određivanje statusa vitamina D kod svih bolesnika sa AC jetre i uvođenje suplementacije vitaminom D kod bolesnika koji imaju nivo 25(OH)D &lt; 80 nmol/l, uz tromesečne kontrole efekta. Kod postavljanja dijagnoze AC jetre potrebno je inicijalno određivanje BMD. Kod suplementacije vitaminom D nakon inicijalnog DXA pregleda sledeći se preporučuje nakon jedne do dve godine.</p> / <p>Introduction: The term Hepatic osteodystrophy defines a group of metabolic bone diseases associated with underlying chronic liver disease. Alcoholic liver cirrhosis (ALC) is characterized by high incidence of vitamin D deficiency that is proportional to the level of liver failure; however, its role in the pathogenesis of hepatic osteodystrophy has not yet been fully elucidated. The level of 25(OH)D best reflects the vitamin D status. ALC is characterized by changed bone metabolic activity and suppressed bone formation, resulting in the decrease in bone mass. The key topic of interest is the achievement of optimal vitamin D status. The attitude of health professionals towards vitamin D supplementation in alcoholic liver cirrhosis has not yet been clearly defined. The aim of the research: Determining of vitamin D levels, investigating the metabolic activity of the bone and bone mass in patients with alcoholic liver cirrhosis (ALC); Determining the effects of vitamin D3 supplementation at the dose 1000 IU/day during a one-year period in relation to metabolic activity of the bone and bone mineral density (BMD) in the investigated patient population. Patients and methods: The research was conducted at the Clinic for Gastroenterology and Hepatology of the Clinical Centre of Vojvodina in Novi Sad. The research was designed as a prospective interventional study implicating vitamin D3 supplementation at the dose 1000 IU/day to patients with ALC. The investigated patient population (1) encompassed 70 male patients diagnosed with ALC. The patients underwent four examinations (P), that is, research phases: P1 &ndash; inclusion of the patient into the study and introduction of vitamin D supplementation; P2, P3 and P4 after 3, 6 and 12 months of vitamin D supplementation treatment, respectively. Each examination included the analysis of liver function, bone metabolism and vitamin D status. At the beginning (P1) and at the end (P4) of the investigation period, bone mineral density (BMD) was measured by means of dual-energy x-ray absorptiometry (DXA) method. Twenty patients dropped out from the research at different stages throughout the investigation period (P1 to P4). The first part of the investigation pertains to the Group of patients who were included into the study (1) and completed the first examination (P1). Fifty patients have completed the entire research according to the foreseen protocol encompassing all examinations and repeated measurements. These patients are considered a Group of patients who completed the research (2) Results: (1): In ALC patients, vitamin D deficiency and decreased osteocalcin levels were established, as well as normal levels of CrossLaps, PTH, total and ionized calcium, phosphorus and magnesium. Osteopenia and osteoporosis were established in 42.65% and 14.71% of patients, respectively. The lowest BMD was measured in the femoral neck in all patients. (2): Vitamin D supplementation resulted in significant increase in 25(OH)D. Analysis of osteocalcin level revealed positive P1/P4 difference, even though the level remained below the lower normal limit. The levels of CrossLaps and PTH revealed negative P1/P4 difference; however, the levels determined at all four measurements were within the reference values. An improvement of BMD for 0.87% was established in lumbar spine, whereas a decrease was noticed in femoral neck (1.87%) and hip (1.65%). Furthermore, an improvement of liver function was established. Conclusions: Improvement of vitamin D status in ALC patients results in an increase of bone formation and improvement of body mass in lumbar spine. Determining the vitamin D status in all patients with ALC is of outmost importance, as well as the vitamin D supplementation of patients with levels of 25(OH)D &lt; 80 nmol/l along with the monitoring of treatment outcome at three-month intervals. Establishment of the diagnosis of alcoholic liver cirrhosis should encompass initial measurement of BMD. In case of vitamin D supplementation treatment, the initial DXA examination should be repeated after the period of one to two years.</p>