Hepatic osteodystrophy: An important matter for consideration in chronic liver disease

Table 1 Prevalence of osteopenia and osteoporosis in chronic liver disease of various etiologies

Ref.	n	Etiology	Prevalence of osteopenia/osteoporosis	Pathogenic mechanisms/ associated factors
Goral et al[14], 2010	55	Child A-B-C cirrhosis	Osteoporosis 37%	Increased TNFα and IL-6 levels
		Mixed etiology		Decreased IGF-1 levels
Wariaghli et al[53], 2010	64	Cirrhosis	Osteoporosis 45.3%	Female sex
		Mixed etiology		Cholestasis
				Lower weight and height
Loria et al[67], 2010	35	Cirrhosis	Osteoporosis 14%	Not specified
		Viral and alcoholic	Osteopenia 26%
George et al[34], 2010	72	Cirrhosis	Low BMD 68%	Low levels of IGF-1
		Viral and alcoholic
Sokhi et al[66], 2004	104	Cirrhosis	Osteoporosis 11.5%	Child B-C stage and female
		Mixed etiology	Osteopenia 34.6%	female
Gallego-Rojo et al[12], 1998	32	Viral cirrhosis	Osteoporosis 53%	Child stage
				IGF-1 serum levels
Auletta et al[72], 2005	30	Chronic viral hepatitis	Osteoporosis 20%	Chronic hepatopathy per se
			Osteopenia 44%
Diamond et al[11], 1989	22	Hemochromatosis	Osteoporosis 45%	Hypogonadism
				Low free testosterone levels
Sinigaglia et al[22], 1997	32	Hemochromatosis	Osteoporosis 28%	Cirrhosis and iron overload
Mounach et al[73], 2008	33	Primary biliary cirrhosis	Osteoporosis 51.5%	Low BMI
				Menopausal status
				Duration of liver disease
				Vitamin D deficiency
Lindor et al[20], 1995	88	Primary biliary cirrhosis	Osteoporosis 35%	not specified
Guañabens et al[74], 1990	20	Primary biliary cirrhosis	Osteoporosis 35%	Duration of liver disease
				Post menopause
				Malabsorption of calcium
Angulo et al[10], 1998	81	Primary sclerosing cholangitis	Osteoporosis 17%	Stage of liver disease
				Associated advanced inflammatory bowel disease
Malik et al[23], 2009	57	Alcoholic	Low BMD (z-score ≤ -2.0) 17.5%	25-hydroxy-vitamin D deficiency
Kim et al[24], 2003	18	Alcoholic	Osteoporosis 22%	Cumulative alcohol intake
			Osteopenia 50%
Gonzalez-Calvín et al[25], 1993	39	Alcoholic	Osteopenia 23%	Cumulative alcohol intake
				Impairment of osteoblastic activity by ethanol

BMD: Bone mass density; BMI: Body mass index; IGF-1: Insulin-like growing factor 1; IL-6: Interleukin-6; TNF: Tumoral necrosis factor.