Osteoporosis in primary biliary cholangitis

Danford, Christopher J.; Trivedi, Hirsh D.; Papamichael, Konstantinos; Tapper, Elliot B.; Bonder, Alan

doi:10.3748/wjg.v24.i31.3513

Cited by 40 publications

(32 citation statements)

References 68 publications

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“…Osteoporosis is a known complication in multiple etiologies of liver disease, but its epidemiology has been studied most extensively in the context of cholestatic liver disease. The prevalence of osteoporosis in PBC ranges from 20% to 45% 7,[17][18][19][20] with the highest prevalence in those with cirrhosis on the liver transplant list. 21 The prevalence of osteoporosis is higher than in age-matched postmenopausal women without PBC or cirrhosis.…”

Section: Epidemiology Of Diseasementioning

confidence: 99%

“…These additional risk factors include but are not limited to severe cholestasis, corticosteroid use, low BMI, postmenopausal women, early menopause, smoking or alcohol abuse. 17 In patients who are on treatment, repeat DEXA should be undergone every 1 to 2 years. 35…”

Section: Diagnosis and Monitoringmentioning

confidence: 99%

“…PBC-related osteoporosis is driven primarily by decreased bone formation compared to postmenopausal osteoporosis, which is secondary mostly to increased bone resorption. 17 Investigating therapies for PBC-specific osteoporosis is needed. Table 1 illustrates the therapies that have been evaluated for PBC.…”

Section: Management Challengesmentioning

confidence: 99%

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<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Trivedi¹,

Danford²,

Goyes³

et al. 2020

CEG

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Primary biliary cholangitis (PBC) is a chronic, cholestatic condition associated with symptoms that directly impact the quality of life in those afflicted with the disease. In addition to pruritus and fatigue, patients with PBC may develop metabolic bone disease from reduced bone density, such as osteopenia and osteoporosis. Osteoporosis increases the risk of fractures, as well as morbidity and mortality. The prevalence of osteoporosis in PBC is expected to increase in conjunction with the rising prevalence of PBC as a whole. Timely diagnosis, prevention and management of osteoporosis are crucial in order to optimize the quality of life. There is a paucity of data evaluating the management of osteoporosis in PBC. The optimal timing for diagnosis and monitoring is not yet established and is guided by expert opinion. National guidelines recommend screening for osteoporosis at the time of diagnosis of PBC. Monitoring strategies are based on results of initial screening and individual risk factors for bone disease. Identifying reduced bone density is imperative to institute timely preventive and treatment strategies. However, treatment remains challenging as efficacious therapies are currently lacking. The data on treatment of osteoporosis in PBC are mostly extrapolated from postmenopausal osteoporosis literature. However, this data has not directly translated to useful treatment strategies for PBC-related osteoporosis, partly because of the different pathophysiological mechanisms of the two diseases. The lack of useful preventive measures and efficacious treatment strategies remains the largest pitfall that challenges the management of patients with PBC. In this review, we comprehensively outline the epidemiology, clinical implications and challenges, as well as management strategies of PBC-related osteoporosis.

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Section: Epidemiology Of Diseasementioning

confidence: 99%

Section: Diagnosis and Monitoringmentioning

confidence: 99%

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<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Trivedi¹,

Danford²,

Goyes³

et al. 2020

CEG

Self Cite

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“…Although large-scale studies are needed, studies investigating patients with chronic liver disease, such as transplant recipients and patients with PBC [205], revealed some beneficial effects of bisphosphonate. It is considered the most powerful drug for patients with chronic liver disease [5,12,18].…”

Section: Managementmentioning

confidence: 99%

Bone Diseases in Patients with Chronic Liver Disease

Jeong

Kim

2019

IJMS

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Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.

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“…Metabolic bone disease associated with cholestatic liver diseases is less frequently reported. With an overall rate of 32.4% of patients with primary biliary cirrhosis (PBC) and 42.3% of patients with primary sclerosing cholangitis (PSC) being affected, this group has a high prevalence of developing an osteopenia or osteoporosis [1,13,14,15,16,17,18]. With alcoholism being an independent factor for the manifestation of an osteoporosis, overall 35.9% of patients suffering from alcoholic liver disease show altered bone metabolism and structure [12,19,20,21].…”

Section: Hepatic Osteodystrophy—definition and Prevalencementioning

confidence: 99%

Hepatic Osteodystrophy—Molecular Mechanisms Proposed to Favor Its Development

Ehnert¹,

Aspera-Werz²,

Ruoß³

et al. 2019

IJMS

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Almost all patients with chronic liver diseases (CLD) show altered bone metabolism. Depending on the etiology, this manifests in a severe osteoporosis in up to 75% of the affected patients. Due to high prevalence, the generic term hepatic osteodystrophy (HOD) evolved, describing altered bone metabolism, decreased bone mineral density, and deterioration of bone structure in patients with CLD. Once developed, HOD is difficult to treat and increases the risk of fragility fractures. Existing fractures affect the quality of life and, more importantly, long-term prognosis of these patients, which presents with increased mortality. Thus, special care is required to support the healing process. However, for early diagnosis (reduce fracture risk) and development of adequate treatment strategies (support healing of existing fractures), it is essential to understand the underlying mechanisms that link disturbed liver function with this bone phenotype. In the present review, we summarize proposed molecular mechanisms favoring the development of HOD and compromising the healing of associated fractures, including alterations in vitamin D metabolism and action, disbalances in transforming growth factor beta (TGF-β) and bone morphogenetic protein (BMP) signaling with histone deacetylases (HDACs) as secondary regulators, as well as alterations in the receptor activator of nuclear factor kappa B ligand (RANKL)–osteoprotegerin (OPG) system mediated by sclerostin. Based on these mechanisms, we give an overview on the limitations of early diagnosis of HOD with established serum markers.

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Osteoporosis in primary biliary cholangitis

Cited by 40 publications

References 68 publications

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

<p>Osteoporosis in Primary Biliary Cholangitis: Prevalence, Impact and Management Challenges</p>

Bone Diseases in Patients with Chronic Liver Disease

Hepatic Osteodystrophy—Molecular Mechanisms Proposed to Favor Its Development

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