title: Bone changes in alcoholic liver disease.
abstract: Alcoholism has been associated with growth impairment, osteomalacia, delayed fracture healing, and aseptic necrosis (primarily necrosis of the femoral head), but the main alterations observed in the bones of alcoholic patients are osteoporosis and an increased risk of fractures. Decreased bone mass is a hallmark of osteoporosis, and it may be due either to decreased bone synthesis and/or to increased bone breakdown. Ethanol may affect both mechanisms. It is generally accepted that ethanol decreases bone synthesis, and most authors have reported decreased osteocalcin levels (a "marker" of bone synthesis), but some controversy exists regarding the effect of alcohol on bone breakdown, and, indeed, disparate results have been reported for telopeptide and other biochemical markers of bone resorption. In addition to the direct effect of ethanol, systemic alterations such as malnutrition, malabsorption, liver disease, increased levels of proinflammatory cytokines, alcoholic myopathy and neuropathy, low testosterone levels, and an increased risk of trauma, play contributory roles. The treatment of alcoholic bone disease should be aimed towards increasing bone formation and decreasing bone degradation. In this sense, vitamin D and calcium supplementation, together with biphosphonates are essential, but alcohol abstinence and nutritional improvement are equally important. In this review we study the pathogenesis of bone changes in alcoholic liver disease and discuss potential therapies.
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: González-Reimers
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Quintero-Platt
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Rodríguez-Rodríguez
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Riera
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Alvisa-Negrín
authors.affiliation: Emilio González-Reimers, Geraldine Quintero-Platt, Eva Rodríguez-Rodríguez, Antonio Martínez-Riera, Julio Alvisa-Negrín, Francisco Santolaria-Fernández, Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, 38320 Canary Islands, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Santolaria-Fernández
keywords: Alcoholism; Bone fractures; Liver disease; Osteoporosis; Vitamin D