title: Osteoporosis in chronic liver disease.
abstract: Osteoporosis is a common skeletal complication seen in patients with chronic liver disease. Osteoporosis is usually asymptomatic and, if untreated, can result in fractures and impaired quality of life. For this review, we performed a systematic search of the PubMed database, and all recent peer-reviewed articles regarding the prevalence, pathophysiology, diagnosis, and management of osteoporosis in chronic liver disease were included. The prevalence of osteoporosis varies between 11% and 58% in patients with chronic liver disease and in transplant recipients. The etiology of osteoporosis is multifactorial and only partially understood. Various factors linked to the pathogenesis of bone loss are vitamin D, calcium, insulin growth factor-1, receptor activation of nuclear factor-κB ligand (RANKL), bilirubin, fibronectin, leptin, proinflammatory cytokines, and genetic polymorphisms. Management of osteoporosis involves early diagnosis, identifying and minimizing risk factors, general supportive care, nutrition therapy, and pharmacotherapy. Osteoporosis is diagnosed based on the bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry scan. Measurement of BMD should be considered in all patients with advanced liver disease and in transplant recipients. Vitamin D and calcium supplementation is recommended for all patients with osteoporosis. Specific agents used for treatment of osteoporosis include bisphosphonates, calcitonin, hormonal therapy, and raloxifene. Bisphosphonates have become the mainstay of therapy for osteoporosis prevention and treatment. Prolonged suppression of bone remodeling resulting in atypical fractures has emerged as a significant complication with long-term use of bisphosphonates. Newer treatment agents and better fracture prevention strategies are necessary to prevent and treat osteoporosis.
authors.affiliation: Division of Transplant Hepatology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
authors.forename: Anitha
authors.initials: A
authors.lastname: Yadav
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Carey
mesh_terms: D015502:Absorptiometry, Photon; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000097:blood; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000235:genetics / Q000378:metabolism; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D044342:Malnutrition / Q000150:complications / Q000503:physiopathology; D009043:Motor Activity; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D053245:RANK Ligand / Q000235:genetics / Q000378:metabolism; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood; D014813:Vitamin K Deficiency / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D002136:Calcium, Dietary; D004164:Diphosphonates; D053245:RANK Ligand; C505688:TNFSF11 protein, human; D014409:Tumor Necrosis Factor-alpha; D014807:Vitamin D; D020849:Raloxifene Hydrochloride; D007334:Insulin-Like Growth Factor I; D002116:Calcitonin; D001663:Bilirubin