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Arch Hellen Med, 33(4), July-August 2016, 596-609


Hepatic osteodystrophy: Current views

Ι. Mani, S.P. Dourakis
Second Department of Internal Medicine, "Hippokratio" General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

Hepatic osteodystrophy (HO) is a general term used to describe a wide range of disorders of bone composition and structure and the consequent effects in patients with chronic liver disease, especially cirrhosis. It is manifest mainly as osteoporosis/osteopenia, and more rarely as osteomalacia. Initially HO was associated with cholestatic liver diseases, but in recent decades the progressive increases in both life expectancy and the numbers of successful liver transplants have revealed the presence of HO in all categories of cirrhosis, regardless of the underlying cause, at a rate of 12–55%. Patients undergoing liver transplantation have a high incidence of osteoporosis and fractures, ranging from 15 to 27%, representing a significant cause of comorbidity and deterioration of quality of life, especially since long-term survival has increased significantly. The diagnosis and estimation of the severity of HO is made using dual-energy X-ray absorptiometry (DEXA). The most frequent and serious manifestation of HO is osteoporosis, which is defined as bone mass density (BMD) of less than 2.5 standard deviations from the mean of the young control population (T score <-2.5). The other subtype of HO, osteopenia, is defined as T score value between -1 and -2.5, while normal values are considered to be >-1.The relevant guidelines recommend that all patients with cirrhosis or liver transplants should undergo DEXA examination. When HO is documented, patient evaluation should include measurement of the serum levels of calcium (Ca) and vitamin D, sex and thyroid hormone tests and X-ray of the thoracic and lumbar spine. Calcium, vitamin D and bisphosphonates are the drugs most widely used in the treatment of HO.

Key words: Cirrhosis, Hepatic osteodystrophy, Liver transplantation, Osteoporosis.

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