Osteoporosis in chronic liver disease
Reviews
Authors
Núria Guañabens, Albert Parés
Accepted manuscript online: 26 February 2018
DOI: 10.1111/liv.13730
Abstract
Osteoporosis is a frequent complication in patients with chronic liver disease, especially in end-stages and in chronic cholestasis, in addition to nonalcoholic fatty liver disease, hemochromatosis and alcoholism. Mechanisms underlying osteoporosis are
poorly understood, but osteoporosis mainly results from low bone formation. In this setting, sclerostin, a key regulator of the Wnt/ß-catenin signalling pathway which regulates bone formation, in addition to the effects of the retained substances of
cholestasis such as bilirubin and bile acids on osteoblastic cells, may influence the decreased bone formation in chronic cholestasis. Similarly, the damaging effects of iron and alcohol on osteoblastic cells may partially explain bone disease in
hemochromatosis and alcoholism. A role for proinflamatory cytokines has been proposed in different conditions. Increased bone resorption may occur in cholestatic women with advanced disease. Low vitamin D, poor nutrition and hypogonadism, may be
contributing factors to the full picture of bone disorders in chronic liver disease.

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