OSTEOPOROSIS IN CHRONIC LIVER DISEASE: PATHOGENESIS, DIAGNOSTICS, AND TREATMENT

Abstract

Osteoporosis is a systemic metabolic disease of the skeleton, characterized by a decrease in bone mass and a violation of the microarchitectonics of bone tissue, which leads to increased fragility and bone fractures. The high social significance of osteoporosis is determined by its consequences – fractures of the vertebrae and bones of the peripheral skeleton, which lead to an increase in morbidity, disability and mortality among the elderly, and therefore to large financial costs of the health care industry. For the timely implementation of preventive measures, risk factors for osteoporosis and fractures are well defined, among which chronic liver diseases occupy a prominent place, as evidenced by the appearance of the term “hepatic osteoporosis (osteodystrophy)”. The aim of the study. To form a more detailed understanding of the genesis of osteoporosis in chronic liver diseases. Materials and methods. In the course of the research, the latest scientific sources on the specified issue were analyzed. Results. The bone system and the mechanisms of its remodeling are largely ignored by hepatologists, despite the obvious damage to bone tissue in hepatitis, cirrhosis of the liver, biliary dysfunction, etc. According to various researchers, osteoporosis is diagnosed in 25–55% of patients with chronic liver disease. The formation of osteopenic syndrome and osteoporosis in liver pathology is multifactorial, and the pathogenetic mechanisms of this process are quite complex and ambiguous. Currently, it is believed that the frequency of osteomalacia in chronic liver disease is exaggerated, and a frequent reaction of bone tissue in chronic hepatitis and liver cirrhosis is osteoporosis. The most rapid and intensive loss of bone mass occurs in autoimmune hepatitis, autoimmune cirrhosis and primary biliary cirrhosis of the liver. To date, the main risk factors for the development of osteoporosis and osteopenic syndrome in chronic liver disease have been identified. It has been established that the formation of hepatogenic osteopathy and osteoporosis is pathogenetically related to the course of chronic hepatitis and cirrhosis of the liver and is an important symptom complex of these diseases. Glucocorticoids (GCs) are the mainstay of treatment for chronic inflammatory diseases and the liver is no exception, so it is important to recognize their negative impact on bone remodeling. They inhibit synthetic osteoblasts, induce their apoptosis, initiate the accumulation of fatty inclusions in hepatocytes, provoking steatohepatitis. Patients who take oral GCs for a long time are at increased risk of developing osteoporosis with significant bone loss in the first months of treatment. Conclusions. Thus, bone tissue is a target organ in chronic liver disease, targeted by inflammatory aggression and affected by numerous biochemical metabolic and hormonal disorders. Therefore, patients with CLD are at risk of developing secondary osteoporosis.