Osteoporosis in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is an autoimmune liver disease that is typically progressive, with a significant proportion of patients going on to develop cirrhosis. It predominately affects women and typically develops in the middle years of life. In most centres the median age for presentation is in the range 55 to 60 years, with a significant proportion of patients first presenting over the age of 65. Due to earlier diagnosis, PBC has gone from being a rare disease, characterised by the complications of end-stage liver disease, to a significantly commoner disease (affecting up to 1 in 700 women over the age of 40) diagnosed often in an asymptomatic stage. Osteoporosis increases with advancing age and hence there is an increased prevalence of osteoporosis in older people. The question of whether osteoporosis occurs as a specific complication of PBC has latterly proved to be controversial. This article reviews the current literature and examines why differences occur in osteoporosis prevalence in the available studies. It becomes clear that when determining the true extent of the association between osteoporosis and PBC, conclusions must be drawn from large populations, and that when considering a disease such as osteoporosis that is common in older people, age matched values be used in order to draw these conclusions. As PBC is a disease that often presents for the first time over the age of 65, it is not surprising that osteoporosis is a common problem in a disease predominately affecting peri- or postmenopausal women.