Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia.
World J Gastroenterol. 2023 Feb 7;29(5):825-833. doi: 10.3748/wjg.v29.i5.825.
Given that the liver is involved in many metabolic mechanisms, it is not surprising that chronic liver disease (CLD) could have numerous complications. Secondary osteoporosis and increased bone fragility are frequently overlooked complications in CLD patients. Previous studies implied that up to one-third of these individuals meet diagnostic criteria for osteopenia or osteoporosis. Recent publications indicated that CLD-induced bone fragility depends on the etiology, duration, and stage of liver disease. Therefore, the increased fracture risk in CLD patients puts a severe socioeconomic burden on the health system and urgently requires more effective prevention, diagnosis, and treatment measures. The pathogenesis of CLD-induced bone loss is multifactorial and still insufficiently understood, especially considering the relative impact of increased bone resorption and reduced bone formation in these individuals. It is essential to note that inconsistent findings regarding bone mineral density measurement were previously reported in these individuals. Bone mineral density is widely used as the "golden standard" in the clinical assessment of bone fragility although it is not adequate to predict individual fracture risk. Therefore, microscale bone alterations (bone microstructure, mechanical properties, and cellular indices) were analyzed in CLD individuals. These studies further support the thesis that bone strength could be compromised in CLD individuals, implying that an individualized approach to fracture risk assessment and subsequent therapy is necessary for CLD patients. However, more well-designed studies are required to solve the bone fragility puzzle in CLD patients.
由于肝脏参与许多代谢机制，因此慢性肝病 (CLD) 可能有许多并发症并不奇怪。继发性骨质疏松症和骨脆性增加是 CLD 患者经常被忽视的并发症。先前的研究表明，多达三分之一的这些人符合骨质疏松症或骨量减少的诊断标准。最近的出版物表明，CLD 引起的骨脆弱取决于病因、疾病持续时间和阶段。因此，CLD 患者的骨折风险增加给医疗系统带来了严重的社会经济负担，迫切需要更有效的预防、诊断和治疗措施。CLD 引起的骨丢失的发病机制是多因素的，目前仍了解不足，尤其是考虑到这些患者中骨吸收增加和骨形成减少的相对影响。值得注意的是，以前在这些患者中报告的骨矿物质密度测量结果不一致。骨矿物质密度广泛用作骨脆性临床评估的“金标准”，尽管它不足以预测个体骨折风险。因此，对 CLD 个体进行了微尺度骨改变（骨微观结构、力学性能和细胞指标）分析。这些研究进一步支持了骨强度可能在 CLD 个体中受损的论点，这意味着需要对 CLD 患者进行个体化的骨折风险评估和后续治疗。然而，需要更多设计良好的研究来解决 CLD 患者的骨脆弱难题。
