Hepatic osteodystrophy: An underrecognized metabolic bone disease

Area of Science:

• Hepatology
• Endocrinology
• Bone Metabolism

Background:

• Hepatic osteodystrophy (HO) is a frequent complication of chronic liver diseases (CLD), presenting as osteoporosis or osteopenia.
• It affects patients with various CLD etiologies, including chronic cholestasis and cirrhosis.
• The prevalence of bone density loss is notably increased in CLD patients.

Purpose of the Study:

• To provide an updated review of hepatic osteodystrophy (HO) in chronic liver diseases (CLD).
• To cover the pathogenesis, management strategies, and current treatment interventions for HO.
• To highlight the need for further research in defining optimal management and treatments for HO.

Main Methods:

• Review of existing literature on hepatic osteodystrophy (HO) and chronic liver diseases (CLD).
• Analysis of multifactorial pathogenetic mechanisms, including genetic, nutritional, hormonal, and lifestyle factors.
• Evaluation of current diagnostic approaches focusing on fracture risk and bone mineral density.

Main Results:

• HO pathogenesis is multifactorial, involving genetic factors, vitamin deficiencies, inflammation, hypogonadism, hyperbilirubinemia, and therapies.
• Management necessitates individualized assessment of fracture risk and bone mineral density.
• Prevention strategies include risk factor mitigation, treating hypogonadism, and promoting healthy lifestyle choices.

Conclusions:

• Current treatment for HO primarily involves bisphosphonates, but their efficacy in fracture reduction is inconsistent.
• Further research is essential to establish definitive management protocols and specific treatments for HO.
• Improved understanding and treatment of HO are crucial for preventing fragility fractures and enhancing the quality of life for CLD patients.