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World J Hepatol. Dec 27, 2011; 3(12): 300-307
Published online Dec 27, 2011. doi: 10.4254/wjh.v3.i12.300
Hepatic osteodystrophy: An important matter for consideration in chronic liver disease
Germán López-Larramona, Alfredo J Lucendo, Sonia González-Castillo, José M Tenias
Germán López-Larramona, Department of Internal Medicine, Hospital General de Tomelloso, 13700 Ciudad Real, Spain
Alfredo J Lucendo, Sonia González-Castillo, Department of Gastroenterology, Hospital General de Tomelloso, 13700 Ciudad Real, Spain
José M Tenias, Research Support Unit, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, 13700 Ciudad Real, Spain
Author contributions: López-Larramona G, Lucendo AJ, González-Castillo S and Tenias JM equally contributed to this manuscript.
Correspondence to: Germán López-Larramona, MD, Department of Internal Medicine, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n, 13700 Tomelloso, Ciudad Real, Spain.
Telephone: +34-926-525097 Fax: +34-926-525870
Received: February 4, 2011
Revised: September 21, 2011
Accepted: November 7, 2011
Published online: December 27, 2011

Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteopenia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.

Keywords: Hepatic osteodystrophy, Liver disease, Osteoporosis, Osteopenia