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.

Loss of skeletal muscle mass in patients with chronic liver disease is related to decrease in bone mineral density and exercise tolerance

“…Surprisingly, this study showed that loss of skeletal muscle mass before surgery in patients with HCC is associated with osteoporosis, independent of age or sex. It is known that osteoporosis is a complication commonly observed in patients with chronic liver disease regardless of cause or severity . Furthermore, it is known that metabolism of muscle and bone is regulated by some common factors such as genetic background, nutrition, lifestyle, and hormones .…”

“…It is known that osteoporosis is a complication commonly observed in patients with chronic liver disease regardless of cause or severity. [36][37][38] Furthermore, it is known that metabolism of muscle and bone is regulated by some common factors such as genetic background, nutrition, lifestyle, and hormones. [39][40][41][42] For example, myokine, an endocrine cytokine or peptide released from muscle, is a potent factor related to the metabolism of both muscle and bone.…”

Associations Between Liver Function, Bone Turnover Biomarkers and Adipokines in Older Patients With Hip Fracture

“…1) Liver plays a fundamental role in metabolism of vitamins D and K, parathyroid hormone (PTH) and minerals, essential regulators of bone homeostasis [1][2][3][4][5]. 2) Osteopenia/ osteoporosis (hepatic osteodystrophy) is present in 20-50% of patients with chronic liver disease [6][7][8][9][10]. 3) Osteocalcin (OC), an osteoblast-derived hormone, is recognized as a critical determinant of energy and glucose homeostasis [11][12][13][14][15][16].…”

Alcoholic liver disease and changes in bone mineral density

“…Some of the adverse effects of bisphosphonates described in the literature include osteonecrosis of the jaw (75) and suppression of bone turnover with the consequent risk of atypical fractures (101). There are no specific guidelines regarding the duration of treatment in patients with CLD and ALD: In general, annual densitometric tests are recommended in CLD with high risk of accelerated bone loss, as is the case in patients with severe cholestasis, on steroid therapy, and in transplanted subjects.…”