Management of osteoporosis in primary biliary cirrhosis

Osteoporosis is not a significant problem in the majority of patients with primary biliary cirrhosis (PBC), However, substantial bone-related morbidit y may occur in patients with advanced disease, in particular after liver tr ansplantation. The cause of osteoporosis in PBC is multifactorial, and path ophysiological mechanisms specifically related to PBC have not been defined . In general, the principles of management followed in post-menopausal oste oporosis also apply in chronic liver disease. Dual energy X-ray absorptiome try is currently the method of choice for monitoring bone mineral density. Avoidance of conditions with potential negative effects on bone mass, and m aintaining adequate serum vitamin D levels and calcium intake form the corn erstone in preventing osteoporosis. Bisphosphonates are the most logical ch oice when specific medical treatment of PBC-associated osteoporosis is indi cated, 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 posttransplant setting.