Bone disorders in cholestatic liver diseases

Osteopenia is a recognised complication of cholestatic liver diseases (CLD), usually ascribed to metabolic bone diseases such as osteomalacia or osteoporosis, with a prevalence from 10 to 56%, depending on the nature of liver disease. 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. Osteopenia predisposes to atraumatic fractures, particularly in PBC patients undergoing orthotopic liver transplantation and treated with high corticosteroid doses. 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. In this review prevalence data, diagnostic tools, pathophysiology and treatment of osteopenia in CLD are discussed.