Severity of cholestasis and advanced histological stage but not menopausal status are the major risk factors for osteoporosis in primary biliary cirrhosis
Open accessAbstract
Background Since primary biliary cirrhosis (PBC) is usually diagnosed in postmenopausal women with minor cholestasis, it has been questioned whether PBC itself represents a further risk for osteoporosis.Aim To assess the prevalence and risk factors for osteoporosis in an unselected series of women with PBC.Patients and methods 142 women with PBC (age: 54.3+/-0.8 years) and an age-matched control group. Osteoporosis was established by densitometry (bone mineral density below -2.5 T-score). Age, duration and severity of PBC, body mass index, menopausal status, histological stage and markers of bone turnover were assessed.Results Prevalence of osteoporosis was higher in PBC (32.4%) than in normal women (11. 1%) (RR: 3.83, 95%CI: 2.59-5.67, P<0.001). Osteoporosis was associated with older age, menopausal status, body mass index, longer PBC duration, advanced histological stage, high bilirubin and alkaline phosphatase, and low albumin and prothrombin index. Regression analysis identified older age, higher Mayo risk score, lower body mass index and advanced histological stage but not menopause as the independent risk factors for osteoporosis.Conclusions Osteoporosis is more prevalent in women with PBC than in the general population. Age and severity of the disease, but not menopausal status, are the main risk factors for osteoporosis in this liver disease.
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Osteoporosis is frequent in PBC, although it is best regarded as a complication of the metabolic changes seen in cholestasis including reduced absorption of fat-soluble vitamins.
“Osteoporosis is frequent in PBC, although it is best regarded as a complication of the metabolic changes seen in cholestasis including reduced absorption of fat-soluble vitamins.111–113”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [112]
The Discussion reports that osteoporosis is a common complication of PBC and associates low bone mass with the severity of cholestasis. The Introduction mentions calcium malabsorption, but the paper does not establish reduced absorption of fat-soluble vitamins as the mechanism for osteoporosis. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRisk factors for osteopenic bone disease in PBC include female gender, menopausal status, low body mass index, older age, advanced disease and chronic cholestasis with resultant vitamin D deficiency.
“Risk factors for osteopenic bone disease in PBC include female gender, menopausal status, low body mass index (through the effects of disordered bile acid homeostasis and the pancreatic insufficiency seen in some patients with PBC), older age, advanced disease and chronic cholestasis with resultant vitamin D deficiency.112”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [112]
The Results and Discussion associate older age, lower BMI, advanced liver disease and cholestasis with osteoporosis in women with PBC. Menopausal status was associated with osteoporosis but was not an independent risk factor. The study included only women, so it cannot establish female gender as a risk factor; it also does not establish the proposed bile-acid or pancreatic mechanism, and the Results found no significant difference in vitamin D levels between patients with and without osteoporosis. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOsteoporosis is a common complication in PBC patients.
“Osteoporosis is a common complication in patients with PBC [230,231].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [230]
Patients with PBC have higher markers of bone resorption (urinary hydroxyproline) and lower markers of bone formation (osteocalcin).
“Patients with PBC also have higher markers of bone resorption (urinary hydroxyproline) and lower markers of bone formation (osteocalcin).112”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [112]
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- Authors
- Guañabens, N., Parés, A., Ros, I., Caballería, L., Pons, F., Vidal, S., Monegal, A., Peris, P., & Rodés, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Guañabens, Núria
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2005-04
- Volume
- 42
- Issue
- 4
- Pages
- 573-577
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W1997996763
- Cited by
- 179
- References
- 26
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 10 · 2020: 12 · 2019: 10 · 2018: 17 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 9 · 2013: 5 · 2012: 6
- FWCI
- 5.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Instituto de Salud Carlos III (C03/02, C03/08)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Keywords
- primary biliary cirrhosis, osteoporosis, risk factors, histological stage, menopause, bone mineral density, body mass index, Mayo risk score, bone turnover markers
- MeSH terms
- Cholestasis, Female, Humans, Liver Cirrhosis, Biliary, Menopause, Middle Aged, Osteoporosis, Risk Factors, Severity of Illness Index, Biomarkers, Bone Density, Body Mass Index, Prevalence, Fractures, Bone
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