Osteoporosis in patients with primary biliary cirrhosis

Abstract

Metabolic bone disease has been recognized as an important complication of chronic liver disease particularly in cholestatic disorders [primary biliary cirrhosis (PBC) and primary sclerosing cholangitis] and after liver transplantation. It includes osteoporosis and more rarely osteomalacia, which is more frequent in severe malabsorption and advanced liver disease. The pathogenesis of this disorder is complex and is likely to be multifactorial. Regardless of the etiology of osteoporosis in PBC patients, they have an increased risk of spontaneous or low-trauma fracturing leading to significant patient morbidity, deterioration of quality of life, and even patient mortality. The development of bone densitometry has allowed assessment of bone mass and then contributed in estimating the fracture risk. The gold standard of bone mineral density measurement is currently the dual- energy X-ray absorptiometry. Recommendations formulated by the World Health Organization have reported the diagnostic ranges of osteoporosis based on the t-score: patient with osteoporosis has a t-score less than -2.5 SD, osteopenia has a t-score between -1.0 and -2.5 SD and a normal individual has a t-score more than -1.0 SD. The risk of fracture shows a correlation with bone mineral density but no fracture threshold was determined and the best site of characterizing the hip fracture risk is the measure of the bone mineral density of the proximal femur. The treatment of osteoporosis in patients with PBC is largely based on trials of patients with postmenopausal osteoporosis as there are a few and smaller studies of osteoporotic patients with PBC. Bisphosphonates seem to be effective in biliary disease and are more tolerated.

The association between liver cirrhosis and fracture risk: A systematic review and meta‐analysis

“…Hyperbilirubinaemia, corticosteroid use, physical inactivity, malnutrition, alcohol intake and impaired vitamin D absorption (resulting from cholestasis) may disturb bone mineralization in cirrhotic patients, leading to osteoporosis . IGF‐1 plays a key role in the process of bone remodelling and maintenance of bone mass, thus the reduced level of IGF‐1 in cirrhotic patients may account for osteoporosis . Additionally, cognitive impairment and psychiatric illness may account for increased fracture risk in cirrhotic patients .…”

“…After excluding the largest sample size study, the pooled OR 18,19 Additionally, cognitive impairment and psychiatric illness may account for increased fracture risk in cirrhotic patients. 20,21 Hepatic encephalopathy is also associated with an increased risk of fall, 22 which will increase the fracture risk.…”

Disease Duration and Stage Influence Bone Microstructure in Patients With Primary Biliary Cholangitis

“…Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis, is an autoimmune liver disease, which affects women nine times more often than men and mostly occurs after the age of 20 years. Both metabolic bone disease and systemic bone loss, reflected by decreased bone mineral density (BMD) and increased risk of fragility fracture, have been outlined repeatedly in PBC, and the etiology of this disorder is thought to be complex and multifactorial. Although in end‐stage disease various risk factors for osteoporosis such as reduced physical activity or malnutrition are present, the contribution of liver dysfunction to bone loss is less clear with earlier stages of the disease.…”

The Effect of Resveratrol on Bone Status in Rats with Bile Duct Obstruction

“…It is known that the risk of fracture strongly correlates with bone mineral density (BMD) and the best site for the hip fracture risk prediction is the measurement of the proximal femur BMD [1]. We therefore analyse the effects of BDO and the resveratrol on body composition, on the BMD, and on the related biomechanical characteristics and metabolic markers of bone tissue.…”

“…These patients have an increased risk of spontaneous or low-trauma fractures leading to significant morbidity, deterioration of quality of life, and even mortality [1,2]. The intesity of bone impairment which typically proceeds as "low-turnover" osteoporosis and related complications in these patients are proportional to the liver damage severity [3].…”