A new research review published in the Journal of Clinical and Translational Hepatology sheds light on a significant but often under-recognized complication of primary biliary cholangitis (PBC): severe bone loss.
PBC, characterized by immune-mediated damage to the small bile ducts within the liver, has long been known for symptoms such as fatigue and itching. However, this new review emphasizes that up to half of individuals with PBC develop osteoporosis, a condition marked by reduced bone density and heightened fracture risk. Fragility fractures not only worsen quality of life but are also linked with an increased risk of death.
Unlike classic postmenopausal osteoporosis, the mechanisms behind bone loss in PBC appear to be multifactorial. The review highlights how chronic inflammation, disruptions in bile acid metabolism and deficiencies in fat-soluble vitamins like vitamins D and K contribute to impaired bone formation and increased bone resorption. Ongoing inflammation may disrupt the balance between osteoblasts, the cells that build bone, and osteoclasts, the cells that break it down.
Additionally, researchers note that the risk of osteoporosis in PBC has been linked with longer disease duration, advanced age, low body weight and severe liver fibrosis.
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The study’s authors say these findings suggest that clinicians should monitor bone health proactively in patients with PBC, using tools such as dual-energy X-ray absorptiometry (DXA) to detect early bone loss.
They also outline current treatment strategies, including vitamin D and calcium supplementation, and call for further research for more targeted therapies in this population.
Medications commonly used to treat osteoporosis in the general population, such as bisphosphonates, have been used in people with PBC, though results have been mixed. Newer drugs are being studied, including denosumab and romosozumab, but more research is needed to determine how well they work specifically in this group.
“With the overall prevalence of PBC rising, a parallel increase in OP incidence among these patients can be anticipated,” the study authors wrote. “Early recognition, preventive strategies, and appropriate therapeutic approaches are essential for preserving patients’ quality of life.”
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