Osteoporosis in patients with chronic liver disease: pathogenesis, diagnosis and treatment

Abstract

Osteoporosis (OP) is a common complication in patients with chronic liver disease (CLD), which remains under the radar of clinicians. About 30% of patients with CLD suffer from OP. The increased risk of fractures in patients with CLD poses a serious socio-economic burden on the healthcare system and requires more effective measures of prevention, diagnosis, and treatment. The purpose of this review is to describe the pathophysiological mechanisms of OP development in CLD and existing diagnostic and therapeutic approaches in the management of such patients. The search in the PubMed database using the keywords "osteoporosis, bone disease, chronic liver diseases, liver cirrhosis" allowed us to select 42 sources published in 2001 – 2023. This review summarises potential mechanisms that underlie and may contribute to the development of OP in CLD. These include changes in vitamin D and calcium metabolism, vitamin K deficiency, hormonal dysregulation, the release of cytokines, sclerostin, changes in gut microbiota, deficiency of insulin-like growth factor-1 (IGF-1), and effects caused by drug intake. The prevalence, risk factors, diagnosis, screening strategies, and treatment of OP in patients with CLD are discussed.