Vitamin D replacement for cirrhosis-related bone disease.
The osteoporotic fracture rate in patients with chronic liver disease is approximately twice that of age-matched, control individuals. About 66% of patients with moderately severe cirrhosis and 96% of patients awaiting liver transplantation have vitamin D deficiency. Studies have shown a strong correlation between vitamin D deficiency and bone density, particularly in the hip. Previous studies of vitamin D therapy in cirrhosis-related bone disease have had major design flaws. Most reports and guidelines on the treatment of hepatic bone disease have concluded that vitamin D deficiency does not have a significant pathogenetic role in the development of osteoporosis in cirrhosis, and that there is no evidence for a therapeutic effect of vitamin D supplementation. Conversely, it is generally recommended that patients with cirrhosis and low bone density should receive calcium and vitamin D supplementation; yet there is a paucity of reliable data on the optimal doses to use, as well as a lack of clearly demonstrated benefit. We believe that clinical trials of vitamin D therapy in these patients with liver disease are warranted. As low-dose oral supplementation often will not normalize vitamin D levels or suppress parathyroid hormone activity in cirrhotic patients, high-dose, parenteral vitamin D might be preferable, but further long-term studies are required to assess the benefits and safety of this approach.
Crawford
Bronwyn A
BA
Royal Prince Alfred Hospital and Concord General Repatriation Hospital, and a Senior Clinical Lecturer in the Faculty of Medicine at the University of Sydney, Australia. brcrawfo@mail.usyd.edu.au
Labio
Eternity D
ED
Strasser
Simone I
SI
McCaughan
Geoffrey W
GW
D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism; D010024:Osteoporosis / Q000209:etiology* / Q000517:prevention & control*; D014807:Vitamin D / Q000378:metabolism / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications*
D004164:Diphosphonates; D014807:Vitamin D