Liver disease in older women

Clinicians are seeing increasing number of patients with chronic liver disease (CLD). The prevalence of diseases such as nonalcoholic fatty liver disease is increasing dramatically, our population is ageing and people with CLD are surviving into old age. Signs and symptoms of CLD in the older patient are often subtle and non-specific and a high index of suspicion is required in order to investigate. A number of diseases, which are predominate in women, tend to present in middle to older age. The menopause may render the liver more susceptible to disease progression and although hormone replacement appears safe in CLD but it is not recommended for liver protection. Osteoporosis is common in CLD but robust evidence is lacking on fracture prevention. Vigilance is required when interpreting investigations as there are no age-associated changes in clinical liver function testing. Management strategies are similar irrespective of age or gender, but evidence is lacking specific to older populations.