Management of osteopenia of liver disease with special emphasis on primary biliary cirrhosis

Bone disease occurring in the setting of chronic liver disease is being recognized increasingly often. The osteopenia may be an important cause of morbidity in these patients, particularly as effective treatments become available for the liver diseases and especially if these treatments actually worsen the coexistent bone disease. Although no specific treatments are of proven benefit for the bone disease in most instances, adequate exercise and calcium intake as well as vitamin D supplementation when deficiencies are present are recommended for all patients. Information is lacking about specific treatment for patients with PSC, hemochromatosis, and alcoholic liver disease. For patients with PBC, other than the above general measures, preliminary information suggests that supplemental estrogens in postmenopausal women and the use of calcitonin may offer promise; both measures are deserving of further study in this group of patients.