Diagnosis and Management of Cirrhosis-Related Osteoporosis

Abstract

Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

Association between sarcopenia and osteoporosis in chronic liver disease

“…53 This finding suggests that high sRANKL levels reflect an increase in bone turnover in liver disease patients and that the OPG/sRANKL ratio might reflect the maintenance of bone homeostasis. 54 Serum myostatin, a negative regulator of muscle protein synthesis, has been reported to be present at significantly higher levels in patients with cirrhosis than in healthy controls. 55,56 Nishikawa et al showed that serum myostatin levels were higher in cirrhotic patients with Child-Pugh B or C than in patients with Child-Pugh A.…”

Multiple vertebral fractures in a liver transplant recipient with HCV cirrhosis: A case report

“…Higher prevalences of fractures are recorded in cholestatic liver disease and according to the severity of liver failure 7 . Moreover, osteoporotic fractures among patients awaiting liver transplantation remain noticeably prevalent (25%) over the last two decades, but fortunately there is a tendency to higher BMD scores and lower rates of fracturing 8,9 .…”

Rheumatic Manifestations in Autoimmune Liver Disease

“…According to the WHO definition, osteoporosis is diagnosed when bone density is less than 2.5 standard deviations below the peak value obtained from normal adults and adjusted for gender (T score) 120 . This definition is limited insofar as the threshold was established from studies of postmenopausal Caucasian women, rather than for patients with liver diseases.…”

“…The prevalence of osteoporosis in cirrhotic patients ranges from 12 to 70% according to the diagnostic modality and the liver disease etiology, with cholestatic diseases having a higher prevalence (20-44%, even without an established diagnosis of cirrhosis). Moreover, fracture rates are increased in cholestatic diseases, varying from 13 to 22% according to the degree of liver function 120 .…”

“…for liver disease patients. Calcitriol is usually prescribed as a daily oral dose of 800 IU but can also be taken at a weekly dose of 5000 IU 120 . In PBC, calcium and vitamin D supplementation alone was inferior to hormonal replacement therapy in improving BMD.…”