title: Management of osteoporosis in liver disease.
abstract: Osteoporosis resulting in a high risk for fracture is a common complication in patients with liver disease, particularly in those with chronic cholestasis and with end-stage cirrhosis. The pathogenesis of bone loss in liver patients is poorly understood but it mainly results from low bone formation as a consequence of cholestasis or the harmful effects of alcohol or iron on osteoblasts. Increased bone resorption has also been described in cholestatic women with advanced disease. The management of bone disease in liver patients is addressed to reduce or avoid the risk factors for osteoporosis and fracture. Bisphosphonates associated with supplements of calcium and vitamin D are safe and effective for increasing bone mass in patients with chronic cholestasis and after liver transplantation, though no clear achievements in descreasing the incidence of fractures have been described, probably because of the low number of patients included in the therapeutic trials. Randomized studies assessing bisphosphonates in larger series of patients, the development of new drugs for osteoporosis and the improvement in the management of liver transplant recipients may change the future.
authors.affiliation: Liver Unit, Department of Rheumatology, Hospital Clínic, CIBERhed, University of Barcelona, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Guañabens
authors.forename: Albert
authors.initials: A
authors.lastname: Parés
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D004164:Diphosphonates / Q000627:therapeutic use; D050723:Fractures, Bone / Q000517:prevention & control; D015438:Health Behavior; D020249:Hormone Replacement Therapy; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D