Pramanik S, Palui R, Ray S. Hepatic osteodystrophy: An underrecognized metabolic bone disease. World J Hepatol 2025; 17(8): 109093 [DOI: 10.4254/wjh.v17.i8.109093]
Corresponding Author of This Article
Sayantan Ray, Assistant Professor, Department of Endocrinology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar 751019, India. sayantan.ray30@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2025; 17(8): 109093 Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.109093
Hepatic osteodystrophy: An underrecognized metabolic bone disease
Subhodip Pramanik, Rajan Palui, Sayantan Ray
Subhodip Pramanik, Department of Endocrinology, Neotia Getwel Healthcare Centre, Siliguri 734010, West Bengal, India
Rajan Palui, Department of Endocrinology, The Mission Hospital, Durgapur 713212, India
Sayantan Ray, Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
Author contributions: Pramanik S performed the literature search, wrote the first draft and provided intellectual input; Palui R and Ras S conceptualized the work, performed a literature search, supervised the writing, provided intellectual input and critically revised the manuscript; Ray S supervised the literature search, the writing, provided intellectual input and critically revised the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sayantan Ray, Assistant Professor, Department of Endocrinology, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar 751019, India. sayantan.ray30@gmail.com
Received: April 29, 2025 Revised: June 10, 2025 Accepted: July 8, 2025 Published online: August 27, 2025 Processing time: 120 Days and 14.2 Hours
Abstract
Hepatic osteodystrophy (HO) is a common and frequently untreated complication, manifested as osteoporosis or osteopenia, encountered in the evolution of chronic liver diseases (CLD). In addition to patients with chronic cholestasis and cirrhosis, patients with CLD from other etiologies may be affected. Several studies have reported an increased prevalence of osteoporosis/osteopenia in patients with CLD. The pathogenesis varies according to etiology and is multifactorial, involving genetic factors, vitamin deficiencies, proinflammatory cytokines, hypogonadism, hyperbilirubinemia, antiviral therapy, corticosteroids, and lifestyle factors. The approach to management should include individualized assessment for fracture risk factors and bone mineral density. Prevention of osteoporosis in CLD relies on the mitigation of risk factors, treatment of underlying hypogonadism, and encouraging a healthy diet and weight-bearing exercise. Treatment trials specific to HO are small, and the primary medical intervention for the treatment of osteoporosis in CLD remains bisphosphonates although the benefit in fracture reduction has not consistently been shown. Further research is necessary to better define the management and specific treatment of HO for the prevention of fragility fractures and to improve the quality of life. This article provides an updated review of HO covering all these aspects.
Core Tip: Hepatic osteodystrophy (HO) is a common complication, manifested as osteoporosis or osteopenia, encountered in the evolution of chronic liver diseases (CLD). Despite being clinically significant, it often represents an underappreciated and underdiagnosed complication of CLD as systematic screening and management remain suboptimal. The general biology of HO, including its pathogenesis, diagnostic tools, and rationale for treatment, has been determined largely empirically from studies of postmenopausal women with osteoporosis. The treatment of HO is limited, reflecting an unmet need for the best possible management of this disorder. Bisphosphonates have been shown to be effective in selected group of patients with CLD.
