Osteoporosis in chronic liver disease: pathogenesis, risk factors, and management.
This article reviews osteoporosis (OP) in adults with chronic liver disease. OP in this setting is characterized in general by low bone turnover. The pathogenesis is unclear but is probably not related to vitamin D abnormalities. Patients at high risk of OP include those with evidence of cirrhosis, hypogonadism, overt calcium malabsorption, steroid therapy and choleostatic liver disease (particularly primary biliary cirrhosis). OP is best managed by adequate calcium intake, regular weight bearing exercise, and the avoidance of alcohol and tobacco smoking. There is probably no reason for vitamin D supplementation. Hormonal replacement therapy when necessary is indicated in males and should be considered in females. Finally, liver transplantation has the potential to improve or stabilize OP in the median term, although it is associated with significant short-term deterioration.
A.W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
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GW
McCaughan
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RB
Feller
D000328:Adult; D015519:Bone Density; D002118:Calcium / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D015914:Estrogen Replacement Therapy; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors
D002118:Calcium