Osteoporosis in Primary Biliary Cirrhosis: Pathogenesis and Treatment
Section snippets
Prevalence of osteoporosis and fractures
The prevalence of bone disease in PBC has changed since the first description because of two main factors: the criteria used for diagnosing osteoporosis and osteomalacia and because patients now are diagnosed in the early stages of the disease and mostly are asymptomatic. In earlier studies, the incidence of bone disease was assessed by radiographs of the spine or by bone biopsy and histomorphometry [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. In the past 2 decades, however, bone mass
Pathogenesis
The mechanisms resulting in osteoporosis in patients who have PBC have not been elucidated completely because some studies indicate increased bone resorption whereas others suggest decreased bone formation [29]. Some histomorphometric reports have revealed increased bone resorption and turnover even in the absence of osteoporosis as an early feature of bone disease in PBC [7]. Reduced trabecular wall thickness and increased bone turnover is proportional to the severity of hepatic dysfunction
Diagnosis
Bone densitometry is the precise procedure for establishing the diagnosis of osteoporosis and should be performed in all patients who have PBC [56]. Additionally, risk factors for low bone mass and fractures should be evaluated, including alcohol abuse, smoking, body mass index lower than 19 kg/m2, early menopause (women under 45 years of age), secondary amenorrhea of more than 6 months, family history of bone fragility fractures and treatment with glucocorticoids (more than 5 mg of prednisone
General measures
A diagram for prevention and treatment of osteoporosis in PBC is shown in Fig. 2. The factors contributing to bone loss should, as far as possible, be reduced to a minimum by stopping alcohol intake and smoking. As much physical activity as possible and exercises aimed at improving the mechanics of spine are advisable.
Whenever possible, a balanced diet should be prescribed because patients who have advanced liver disease frequently have little appetite and are malnourished. Supplements of
Summary
Osteoporosis is a complication frequently observed in patients who have PBC. The pathogenesis of osteoporosis is characterized mainly by low bone formation, although increased bone resorption also is described, especially in cholestatic women who have advanced liver disease. Osteoporosis is associated with severity of liver disease, older age, and the duration of cholestasis. Patients who have osteoporosis and those who have a lumbar T score below −1.5 have a high risk for fractures,
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2020, How Sex and Gender Impact Clinical Practice: an Evidence-Based Guide to Patient CareEvaluation of the osteoporosis patient
2020, Marcus and Feldman’s OsteoporosisPrimary biliary cholangitis
2018, Medicina ClinicaCurrent Treatment Options for Primary Biliary Cholangitis
2018, Clinics in Liver DiseaseCitation Excerpt :The development of osteoporosis in PBC has been thought to be associated with decreased bone formation and increased bone resorption in the setting of cholestasis and cirrhosis.106 Malnutrition and vitamin deficiencies, particularly vitamins D and K, also contribute to the development of osteoporosis in PBC.107 The diagnosis of osteoporosis is made with a dual energy x-ray absorptiometry scan of the lumbar spine and femur.
EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis
2017, Journal of HepatologyMetabolic Bone Disease in Primary Biliary Cirrhosis
2016, Gastroenterology Clinics of North AmericaCitation Excerpt :Overall, 7% to 14% of patients with PBC sustain fractures and this risk rises to 20% in patients with end-stage PBC.21 Because the estrogen deficiency in menopause is a well-known risk factor of osteoporosis and PBC is primarily a disease of postmenopausal women, there has been some speculation about whether PBC specifically increases the risk of osteoporosis.17 Patients with PBC are 4 times more likely to have osteoporosis and are twice as likely to sustain a fracture compared with age-matched controls, confirming the association between liver disease and osteoporosis.22,23