BACKGROUND & AIMS-Osteopenic bone disease occurs frequently among patients with chronic liver disease but has not been well studied in those with primary sclerosing cholangitis (PSC). We investigated the prevalence, rate of progression, and independent predictors of bone disease in a large number of patients with all stages of PSC.

Synopsis Non-alcoholic bland steatosis and nonalcoholic steatohepatitis (NASH) are stages in the spectrum of nonalcoholic fatty liver disease (NAFLD). NASH may progress to end-stage liver disease with liver-related morbidity and mortality occurring almost exclusively in patients with NASH whose disease had progressed to advanced fibrosis and cirrhosis. Liver biopsy is the only accurate tool available to distinguish between patients with NASH and no NASH and to stage fibrosis which is important for patient counseling and monitoring. Markers of hepatocyte apoptosis such as cytokeratine (CK)-18 measured in plasma hold promise as a non-invasive test for NASH diagnosis. Several scoring systems that combine routine clinical and laboratory variables and some proprietary panels can assist in predicting fibrosis severity. Noninvasive imaging modalities such as ultrasound-based elastography (FibroScan), and particularly magnetic resonance-based elastography (MRE) are reasonably accurate available tools to determine severity of fibrosis in NAFLD, but none of them yet can replace liver biopsy.

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