HEPATIC OSTEODYSTROPHY IN PRIMARY BILIARY-CIRRHOSIS - EFFECTS OF MEDICAL-TREATMENT

Objectives: Osteoporosis is a frequent extrahepatic complication of pr imary biliary cirrhosis. Although histologically similar to the osteop orosis commonly seen in postmenopausal females, the pathogenesis and m anagement of bone disease in patients with primary biliary cirrhosis i s poorly understood. The experience with a subgroup of patients with p rimary biliary cirrhosis treated with vitamin D, calcium, and estrogen supplementation was reviewed to determine the effects of medical trea tment on hepatic osteodystrophy. Methods: The records of 203 women wit h the diagnosis of primary biliary cirrhosis were reviewed retrospecti vely for lumbar spine bone mineral density, menopausal status, and sup plementation with vitamin D, calcium, and estrogen. Results: The 16 po stmenopausal patients treated with estrogen replacement had a statisti cally significant increase in the lumbar spine bone mineral density at 1 yr (+0.014+/-0.049 vs. -0.03+/-0.046 g/cm(2), p<0.038), without a s ignificant change in the serum bilirubin or alkaline phosphatase. In t reated patients, vitamin D and calcium supplementation did not lead to significant improvement in lumbar spine bone mineral density. Conclus ions: Calcium and vitamin D supplementation, even in the presence of v itamin D deficiency, do not improve lumbar spine bone mineral density in patients with primary biliary cirrhosis. Estrogen replacement in po stmenopausal patients, however, does appear to improve lumbar spine bo ne mineral density without increasing clinical or biochemical cholesta sis, a potential complication reported in animal studies. This study s hould serve as an impetus for a controlled trial of estrogen replaceme nt in postmenopausal patients with primary biliary cirrhosis.