Osteoporosis in chronic cholestatic liver disease

Assessment for both trabecular and cortical osteoporosis was carried out in 36 unselected patients with chronic cholestatic liver disease of whom a number had received corticosteroids during the course of their illness. Symptoms suggestive of osteoporosis were present in 42 per cent of patients of whom 11 per cent had evidence of one or more wedged or collapsed vertebrae. There was a highly significant decrease in the cortical area (total area ratio of the second metacarpal (p = 0.05), bone mineral content at the metaphyseal site of the radius (p = 0.01) and the total trabecular bone volume of the iliac crest biopsies (p = 0.005) in the 31 female patients when compared with age and sex-matched healthy controls). There was a nonsignificant decrease in total trabecular bone volume of the iliac crest and bone mineral content of the radial metaphysis in the males compared with age and sex-matched controls but the cortical plate thickness of the iliac crest (p = 0.005) and bone mineral content of the radial diaphysis (p = 0.02) were significantly higher. In total, 42 per cent of patients had evidence of either excessive cortical (28 per cent) and/or trabecular (36 per cent) bone loss as judged by radiological and histological criteria. Only the total trabecular bone volume of the iliac crest, of all the parameters measured was significantly (p = 0.02) lower in patients with backache compared with those without back pain. Significantly greater bone loss was demonstrated at all sites measured in those patients that were receiving or had received corticosteroids in the past.