Hepatic osteodystrophy

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.

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.