Treatment of bone disorders in liver disease

Abstract

Bone disease is a major complication in patients with chronic liver disease since it can result in fragility fractures, which have a significant impact on morbidity, quality of life and even survival. The term hepatic osteodystrophy has been used for years to characterize the bone disease of patients with liver damage, including poor bone mineralization or osteomalacia as the consequence of calcium and vitamin D malabsorption, and osteoporosis. Osteomalacia is uncommon in patients with liver disease, and it is associated with severe and prolonged cholestasis and vitamin D deficiency. Osteoporosis is highly prevalent in patients with liver disease, and it is characterized by loss of bone mass and strength that leads to fragility fractures [1]. Currently the diagnosis of osteoporosis lies in the assessment of bone mineral density. According to the recommendations of the World Health Organization a postmenopausal woman is considered to have osteoporosis when bone mineral density is 2.5 standard deviations below the young average value (T-score < 2.5) and to have osteopenia when the T-score is between 1 and 2.5 [2]. For men, the same threshold used for women is appropriate, because for any given bone mineral density, the adjusted fracture risk is more or less the same. Severe or ‘established’ osteoporosis refers to individuals who meet densitometric criteria and have radiographic evidence of one or more fragility fractures. This review describes the prevalence, the current knowledge of the pathogenesis of bone disorders in