Bone involvement in patients with chronic cholestasis

Osteopenia is a classic complication of chronic cholestasis related to primary biliary cirrhosis or primary sclerosing cholangitis. Most studies were done in patients with primary biliary cirrhosis, which is by far the more common of the two diseases. Estrogen deficiency may be the main cause of bone loss in these patients, most of whom are perimenopausal women. Liver disease severity does not seem to play a major role, although a high bone turnover rate is seen in some patients before the menopause. The fracture risk has not been accurately evaluated, and the limited data on management indicate that hormone replacement therapy is effective and safe, whereas bisphosphonates have not been proven effective. Primary sclerosing cholangitis is rare and, consequently, few data are available. Males are predominantly affected. Concomitant inflammatory bowel disease and glucocorticoid therapy are the main causes of bone loss in primary sclerosing cholangitis.