Osteoporosis and fractures in liver disease: Relevance, pathogenesis and therapeutic implications

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 28; pp. 9427 - 9438
• Main Author: Nakchbandi, Inaam A
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.07.2014
• Subjects: Animals; Bone and Bones - metabolism; Bone and Bones - pathology; Bone Density Conservation Agents - therapeutic use; Bone Remodeling; Calcium - therapeutic use; Dietary Supplements; disease; Fracture; Humans; Liver; Liver - metabolism; Liver Diseases - diagnosis; Liver Diseases - epidemiology; Liver Diseases - metabolism; Liver Diseases - therapy; Osteoporosis; Osteoporosis - diagnosis; Osteoporosis - epidemiology; Osteoporosis - metabolism; Osteoporosis - therapy; Osteoporotic Fractures - diagnosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - metabolism; Osteoporotic Fractures - prevention & control; Pat; Predictive Value of Tests; Prevalence; Review; Signal Transduction; Treatment Outcome; Vitamin D - therapeutic use; Osteoporosis; Therapy; Prevalence; Calcium; Vitamin D; Pathogenesis; Liver disease; Fracture; Insulin like growth factor-I; Fibronectin
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i28.9427

It is being increasingly recognized that patients with liver disease develop bone loss that can be severe enough to lead to atraumatic fractures and thus markedly diminish life quality and expectancy.The estimated prevalence for liver-related osteoporosis is between20-420/100000 of the general population,and fractures between 60-880/100000.It should be kept in mind that up to 40%of patients with chronic liver disease may experience a fracture.The pathogenic mediators include fibronectin,insulin like growth factor-Ⅰ,and various cytokines,but decreased vitamin D and/or treatment with corticosteroids contribute to worsening bone health.Despite the advances in bone biology that have shed some light on the pathogenesis of this bone loss,treatment options remain nonspecific and tightly linked to treatments of other forms of osteoporosis.Thus,treatment should include calcium and vitamin D supplementation in all patients with chronic liver disease.Therapy with bisphosphonates should be considered,especially in patients receiving corticosteroids.This review focuses on the prevalence of this entity as well as the evidence available with regard to the pathogenesis of bone loss in liver disease,the diagnostic steps required in all patients,and the therapeutic options available.