Hepatic osteodystrophy.
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Date
2010-04
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Abstract
Hepatic Osteodystrophy (HO) is a generic definition for the metabolic bone disease that
may occur in individuals with chronic liver disease. Hepatic Osteodystrophy is an important
but frequently overlooked complication, seen in chronic liver disease patients. This review
article illustrates its significance, various causes and methods to diagnose this complication
and recent advances and recommendations to treat Hepatic Osteodystrophy. Two distinct
bone metabolic processes, osteoporosis (OP) and osteomalacia (OM) are combined
together in various proportions in HO syndromes. It has been described in association
with most types of chronic liver disease both cholestatic and non-cholestatic. Primary
biliary cirrhosis (PBC) is the condition causing osteopenia more frequently, but other
cholestatic liver diseases like primary sclerosing cholangitis (PSC), haemochromatosis
and alcoholic liver disease are also frequently associated with this disorder. The
pathogenesis of bone disease in both adults and children with chronic cholestasis is not
completely understood. There has been considerable disagreement regarding the relative
importance of osteomalacia versus osteoporosis as the factors leading to osteopenia of
liver disease. It can significantly affect morbidity, and quality of life of these patients. Fractures
are also associated with an excess mortality. Bone mineral density measurement is the
best way to assess the presence and severity of osteopenia in CLD patients, while laboratory
tests give important information about the metabolic status of the bone. Since advanced
HO is difficult to treat and adversely affects both the quality of life and the long-term prognosis
of patients with chronic liver disease, special care is required in order to prevent the
development of clinical bone disease in individuals with advanced hepatic disease.
Conclusion: Hepatic Osteodystrophy is under-recognized and less attended complication
of CLD. Multiple factors contribute to the development of hepatic Osteodystrophy. Newer
diagnostic modalities have improved the detection of HO and Vitamin D repletion, calcium
supplementation and Bisphosphonates seem promising. The best course of management
for these patients is to review the individual risk factors for osteoporosis, obtain a bone mass measurement, and prescribe age and disease-specific therapies.
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Keywords
Hepatic Osteodystrophy, Chronic liver disease
Citation
Goel Varun, Kar Premashis. Hepatic osteodystrophy. Tropical Gastroenterology. 2010 Apr-June; 31(2): 82-86.