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

Table 1 Epidemiology of bone abnormalities in liver disease

1Prevalence of liver diseases[12]
Cirrhosis	0.10%
Non-alcoholic liver disease	2%-44%
Chronic hepatitis B between	0.1%-0.7%
Chronic hepatitis C	0.003%-4.5%
Autoimmune liver diseases	0.03%
Liver transplantations	5000/yr
Total	2.233%-49.36%
In patients with liver disease
Prevalence of osteoporosis[13,14]	1%-21%
Estimated prevalence	20-420 osteoporotic patients/2000 patients with liver disease/100000 persons
Fractures[13,14]	3%-44%
Estimated risk	60-880 osteoporotic patients/2000 patients with liver disease/100000 persons

¹The data on the prevalence of liver diseases are obtained from a study limited to Europe.

Table 2 Predominant changes in bone cell activity in various liver diseases

Increased resorption	Viral hepatitis
	Transplantation
	Corticosteroid therapy
Decreased formation	Cholestatic liver disease
	Iron and copper overload

Table 3 Factors implicated in inducing bone loss in liver disease

Fibronectin (plasma and oncofetal forms)

IGF-I

RANKL/OPG

IL-6

Sex hormones

Bilirubin

Vitamin D metabolism

Corticosteroid therapy

IGF-I: Insulin like growth factor-I; IL: Interleukin; OPG: Osteoprotegerin; RANKL: Receptor-activator of nuclear factor kappa ligand.

Table 4 Diagnostic testing

Vitamin D (not needed if supplementation contemplated)

Calcium (to exclude endocrine problems)

Bone mineral density measurement (particularly if considering corticosteroid therapy)

Table 5 Therapy

All patients

Vitamin D supplementation

Calcium supplementation

Depending on the general condition and confounding problems

Consider Bisphosphonate therapy, especially in patients receiving corticosteroids)