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  • Review Article
  • Published:

Current understanding of osteoporosis associated with liver disease

Nature Reviews Gastroenterology & Hepatology volume 6, pages 660–670 (2009)Cite this article

Abstract

Osteoporosis is a common complication of many types of liver disease. Research into the pathogenesis of osteoporosis has revealed that the mechanisms of bone loss differ between different types of liver disease. This Review summarizes our current understanding of osteoporosis associated with liver disease and the new advances that have been made in this field. The different mechanisms by which cholestatic and parenchymal liver disease can lead to reduced bone mass, the prevalence of osteopenia and osteoporosis in patients with early and advanced liver disease, and the influence of osteoporotic fractures on patient survival are discussed along with the advances in our understanding of the molecular pathways associated with bone loss. The role of the CSF1–RANKL system and that of the liver molecule, oncofetal fibronectin, a protein that has traditionally been viewed as an extracellular matrix protein are also discussed. The potential impact that these advances may have for the treatment of osteoporosis associated with liver disease is also reviewed.

Key Points

  • Metabolic bone disease is a common complication of chronic liver disease; patients with chronic liver disease have an increased risk of bone fractures, which affects patient survival and well being

  • Osteoporosis is uncommon in patients with early liver disease but affects up to 50% of patients with cirrhosis

  • The cause of bone loss in patients with chronic liver disease is multifactorial and differs between types of liver diseases

  • Levels of osteoprotegerin are elevated and levels of RANKL are decreased in patients with liver disease and osteoporosis

  • Factors that may contribute to bone loss include oncofetal fibronectin and CSF1 in patients with cholestatic liver disease, and TNF in patients with viral hepatitis and alcoholic liver disease

  • Current therapy for bone loss relies on supportive measurements with calcium and vitamin D supplementation; bisphosphonate therapy is efficacious and safe for patients with primary biliary cirrhosis

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Figure 1: Factors that affect bone turnover in patients with liver disease.

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  1. Max-Planck Institute for Biochemistry, Martinsried, Germany

    Inaam A. Nakchbandi

  2. Department of Immunology, Hepatology and Gastrointestinal Research Laboratory, University of Pretoria, South Africa

    Schalk W. van der Merwe

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Nakchbandi, I., van der Merwe, S. Current understanding of osteoporosis associated with liver disease. Nat Rev Gastroenterol Hepatol 6, 660–670 (2009). https://doi.org/10.1038/nrgastro.2009.166

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