Diagnosis and Management of Cirrhosis-Related Osteoporosis

Abstract

Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

Figure 1

Factors that can be involved in cirrhosis-related osteoporosis by modulating the activity of osteoblastic and osteoclastic cells. The factors most related to osteoblastic activity are illustrated in the left column. The factors related to both osteoblastic and osteoclastic activity are displayed in the middle column. The factors most related to osteoclastic activity are shown in the right column. OPG = osteoprotegerin; RANKL = receptor activator of nuclear factor kβ; IGF-1 = insulin-like growth factor 1. Although most factors are related to osteoblastic activity, malnutrition and alcohol abuse have a broad effect on bone loss because they can be involved in other risk factors displayed above, such as leptin levels and vitamin deficiencies.