Treatment of bone disorders in liver disease

Parés, Albert; Guañabens, Núria

doi:10.1016/j.jhep.2006.06.007

Cited by 44 publications

(42 citation statements)

References 82 publications

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“…There has been some debate, along with some differences in recommendations, about when to assess bone density in patients with chronic liver disease, 2,3,33 and this reflects the difficulty of predicting the risk of osteoporosis and fracture on an individual basis ( Table 4). The path of least resistance is to assess BMD in all patients with chronic liver disease.…”

Section: Assessment and Indications For Bmdmentioning

confidence: 99%

“…In younger patients with chronic liver disease, treatment is indicated if BMD shows a T score of less than Ϫ2.5. [1][2][3]33 Although serum markers of bone turnover, such as procollagen peptides of type 1 collagen, are being used in postmenopausal osteoporosis to assess the response to treatment, they have been poorly studied in patients with chronic liver disease and currently cannot be used in patients with chronic liver disease.…”

Section: Assessment and Indications For Bmdmentioning

confidence: 99%

“…There have been only a few small studies of patients with chronic liver disease, mainly PBC, and improvements in BMD rather than more clinically important fracture rates have been used as outcome measurements (reviewed in Pares and Guanabens 33 ).…”

Section: Treatmentmentioning

confidence: 99%

“…2 In a further study of 76 patients with cirrhosis, 1-alpha-25-hydroxyvitamin D3 resulted in a small increase in BMD at the lumbar spine, but no data were given on the effect on fractures. 34 Given the low serum levels of vitamin D in patients with cirrhosis, rising PTH level, and falling urinary calcium loss after transplantation, further studies of Pares and Guanabens 33 Cirrhosis…”

Section: Vitamin Dmentioning

confidence: 99%

“…These drugs are usually given with calcium and vitamin D. They have been studied only in a small number of patients with chronic liver disease, and so data on their efficacy in this setting are lacking (reviewed in Pares and Guanabens 33 ). Most studies have been conducted with PBC patients rather than patients with cirrhosis.…”

Section: Bisphosphonatesmentioning

confidence: 99%

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Bone disorders in chronic liver disease

2007

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Osteomalacia rarely occurs in adult patients with chronic liver disease despite a low serum vitamin D level being reported in up to two-thirds of patients with cirrhosis. In contrast, osteoporosis, which increases the risk of vertebral fractures, occurs in 12%-55% of patients with cirrhosis. Although the prevalence is probably falling, as shown by a fall from 57%-26% in patients with biliary disease requiring liver transplantation over the last 2 decades, it still accounts for significant patient morbidity. Bone density also falls in the first 3 months after liver transplantation, and pretransplant fractures are predictive of posttransplant fractures. Many of the known risk factors for postmenopausal osteoporosis exist in the cirrhotic population, such as excess alcohol intake, steroid use, poor nutrition, and hypogonadism. There is also an increased risk of osteoporosis in patients without cirrhosis, particularly those with hemochromatosis and biliary disease. The diagnosis is made with bone density measurements. The effective treatment is largely based on evidence from postmenopausal osteoporosis as there have been only a few small clinical trials of patients with chronic liver disease. Bisphosphonates are the mainstay of treatment; they have been shown to be effective in biliary disease and are well tolerated. (HEPATOLOGY 2007;46:1271-1278

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Section: Assessment and Indications For Bmdmentioning

confidence: 99%