Osteoporosis in Chronic Liver Disease
Division of Transplant Hepatology, Mayo Clinic, Phoenix, Arizona. Nutrition in Clinical Practice
(Impact Factor: 2.4).
12/2012; 28(1). DOI: 10.1177/0884533612470145
Osteoporosis is a common skeletal complication seen in patients with chronic liver disease. Osteoporosis is usually asymptomatic and, if untreated, can result in fractures and impaired quality of life. For this review, we performed a systematic search of the PubMed database, and all recent peer-reviewed articles regarding the prevalence, pathophysiology, diagnosis, and management of osteoporosis in chronic liver disease were included. The prevalence of osteoporosis varies between 11% and 58% in patients with chronic liver disease and in transplant recipients. The etiology of osteoporosis is multifactorial and only partially understood. Various factors linked to the pathogenesis of bone loss are vitamin D, calcium, insulin growth factor-1, receptor activation of nuclear factor-κB ligand (RANKL), bilirubin, fibronectin, leptin, proinflammatory cytokines, and genetic polymorphisms. Management of osteoporosis involves early diagnosis, identifying and minimizing risk factors, general supportive care, nutrition therapy, and pharmacotherapy. Osteoporosis is diagnosed based on the bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry scan. Measurement of BMD should be considered in all patients with advanced liver disease and in transplant recipients. Vitamin D and calcium supplementation is recommended for all patients with osteoporosis. Specific agents used for treatment of osteoporosis include bisphosphonates, calcitonin, hormonal therapy, and raloxifene. Bisphosphonates have become the mainstay of therapy for osteoporosis prevention and treatment. Prolonged suppression of bone remodeling resulting in atypical fractures has emerged as a significant complication with long-term use of bisphosphonates. Newer treatment agents and better fracture prevention strategies are necessary to prevent and treat osteoporosis.
Available from: Jaime Aranda-Michel
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ABSTRACT: Protein-energy malnutrition (PEM) is a common problem in patients with end-stage liver disease, and it is universally present in patients undergoing orthotopic liver transplantation. Although PEM is an independent risk factor for morbidity and mortality, it need not be considered an absolute contraindication for liver transplantation. The etiology of PEM in liver disease is multifactorial and includes decreased nutrient and calorie intake, alterations in intestinal malabsorption and/or maldigestion, and diverse abnormalities of carbohydrate, fat, and protein metabolism. This article reviews the prevalence of malnutrition, its pathophysiology, different modalities for assessment of body composition, and general guidelines for nutritional support in patients with liver disease and liver transplantation.
Current Gastroenterology Reports 09/2001; 3(4):362-70. DOI:10.1007/s11894-001-0061-0
Available from: scielo.isciii.es
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ABSTRACT: Objectives: To know the prevalence of osteopenia and osteoporosis in alcoholic cirrhotic males from 45 to 65 years old. To prove if the nutritional state is involved in the loss of bone mass in the hepatic disea- se. Material and methods: Study population: 52 alcoholic cirrhotic males from 45 to 65 years old, with normal kidney function , non-seden- tary and with no treatment that could alterate the study. Design and variables: transversal descriptive study finished in 2 years. The nutritio- nal state was evaluated by means of classic anthropometric parameters (weight, height, perimeter of the arm and skin folds) and total body den- sitometry (DPX plus LUNAR-DEXA with dual energy X-ray absorptio- metry. Statistical analysis: Mc Intosh computer (Filemaker PRO pro- gram). T Student was used to compare groups and p was significant if alpha 0.05. Clinical severity of cirrhosis: Child-Turcotte classifica- tion. Results: Osteopenia was diagnosed if bone mineral density (BMD) was higher than 1 standard deviation (SD) but lower than 3 SD below T score (mean values for adult women) and osteoporosis (OP) if BMD was higher than 3 SD or vertebral compression fractures appeared in simple radiographies. The prevalence of bone disease was 58%. The percentages of fat obtained by means of anthropometric and densitometric measures were higher in non-osteopenic patients. Discussion: The prevalence of bone disease was higher than another studies. The total body densitometry is a more exact method to measure the percentage of body fat. The percentages of fat obtained with both met- hods were not related to the loss of bone mass. The nutritional state as an isolated factor does not lead to bone disease in these patients.
Anales de medicina interna (Madrid, Spain: 1984) 01/2002; 19(10). DOI:10.4321/S0212-71992002001000002
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ABSTRACT: The liver is an incredibly complex organ. It performs more than 500 metabolic functions, many of which are related to nutrition (Table 1). I never cease to be amazed at how nutrition and the liver are closely intertwinedhow one can be the cause of deficiencies in the other, or how improvements in one condition improve conditions in the other. Extremes of nutrition status (ie, malnutrition or obesity) can cause liver dysfunction. On the other hand, liver dysfunction can cause nutrient deficiencies, and nutrients can either cause or treat liver disease. The aim of this Commentary is to explore some of the interrelations and complex connections between nutrition and liver disease and set the stage for this issue of Nutrition in Clinical Practice (NCP).
Nutrition in Clinical Practice 02/2013; 28(1):12-4. DOI:10.1177/0884533612473156 · 2.40 Impact Factor
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