Wolfhagen F H, van Buuren H R, Vleggaar F P, Schalm S W
Department of Hepatogastroenterology, Erasmus University Hospital, Rotterdam, The Netherlands.
Baillieres Best Pract Res Clin Gastroenterol. 2000 Aug;14(4):629-41. doi: 10.1053/bega.2000.0108.
Osteoporosis is not a significant problem in the majority of patients with primary biliary cirrhosis (PBC). However, substantial bone-related morbidity may occur in patients with advanced disease, in particular after liver transplantation. The cause of osteoporosis in PBC is multifactorial, and pathophysiological mechanisms specifically related to PBC have not been defined. In general, the principles of management followed in post-menopausal osteoporosis also apply in chronic liver disease. Dual energy X-ray absorptiometry is currently the method of choice for monitoring bone mineral density. Avoidance of conditions with potential negative effects on bone mass, and maintaining adequate serum vitamin D levels and calcium intake form the cornerstone in preventing osteoporosis. Bisphosphonates are the most logical choice when specific medical treatment of PBC-associated osteoporosis is indicated, as well as for preventing bone loss during glucocorticoid treatment and after liver transplantation. Recent studies suggest that active vitamin D analogues are effective alternatives in the post-transplant setting.
骨质疏松症在大多数原发性胆汁性肝硬化（PBC）患者中并非重大问题。然而，晚期疾病患者，尤其是肝移植后，可能会出现大量与骨相关的发病情况。PBC 中骨质疏松症的病因是多因素的，与 PBC 具体相关的病理生理机制尚未明确。一般来说，绝经后骨质疏松症的管理原则也适用于慢性肝病。双能 X 线吸收法是目前监测骨密度的首选方法。避免对骨量有潜在负面影响的情况，维持足够的血清维生素 D 水平和钙摄入量是预防骨质疏松症的基石。当需要对 PBC 相关骨质疏松症进行特定药物治疗时，以及在糖皮质激素治疗期间和肝移植后预防骨质流失时，双膦酸盐是最合理的选择。最近的研究表明，活性维生素 D 类似物在移植后情况下是有效的替代药物。
