Published online Aug 21, 2018. doi: 10.3748/wjg.v24.i31.3513
Peer-review started: June 1, 2018
First decision: July 6, 2018
Revised: July 11, 2018
Accepted: July 22, 2018
Article in press: July 22, 2018
Published online: August 21, 2018
Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease with multiple debilitating complications. Osteoporosis is a common complication of PBC resulting in frequent fractures and leading to significant morbidity in this population, yet evidence for effective therapy is lacking. We sought to summarize our current understanding of the pathophysiology of osteoporosis in PBC, as well as current and emerging therapies in order to guide future research directions. A complete search with a comprehensive literature review was performed with studies from PubMed, EMBASE, Web of Science, Cochrane database, and the Countway Library. Osteoporosis in PBC is driven primarily by decreased bone formation, which differs from the increased bone resorption seen in postmenopausal osteoporosis. Despite this fundamental difference, current treatment recommendations are based primarily on experience with postmenopausal osteoporosis. Trials specific to PBC-related osteoporosis are small and have not consistently demonstrated a benefit in this population. As it stands, prevention of osteoporosis in PBC relies on the mitigation of risk factors such as smoking and alcohol use, as well as encouraging a healthy diet and weight-bearing exercise. The primary medical intervention for the treatment of osteoporosis in PBC remains bisphosphonates though a benefit in terms of fracture reduction has never been shown. This review outlines what is known regarding the pathogenesis of bone disease in PBC and summarizes current and emerging therapies.
Core tip: This article reviews the available literature on the pathophysiology and management of osteoporosis in primary biliary cholangitis (PBC). PBC-related osteoporosis is driven mainly by decreased bone formation as opposed to the increased bone resorption seen in postmenopausal osteoporosis. Despite this and a lack of evidence of efficacy, bisphosphonates remain the cornerstone of treatment. Future attention should be given to the use of anabolic bone agents in the treatment of PBC-related osteoporosis.