Primary Biliary Cholangitis–associated Osteoporosis (IMAGE)
Caption
Primary biliary cholangitis (PBC) is a chronic cholestatic disorder in which symptoms exert a direct influence on patients’ quality of life. Beyond pruritus and fatigue, patients with PBC are also prone to developing osteoporosis (OP). This skeletal condition not only heightens the likelihood of fractures but is also associated with elevated mortality. With the overall prevalence of PBC rising, a parallel increase in OP incidence among these patients can be anticipated. Early recognition, preventive strategies, and appropriate therapeutic approaches are essential for preserving patients’ quality of life. Nevertheless, current data on the management of OP in PBC remain limited. Most existing recommendations are extrapolated from studies on postmenopausal OP. However, these findings have not been effectively adapted into practical management protocols for PBC-related OP, largely due to distinct pathophysiological mechanisms between the two conditions. The absence of well-established preventive and therapeutic measures continues to represent a major obstacle in addressing OP among patients with PBC.
OP represents a prevalent complication among patients with PBC. The underlying pathogenesis is predominantly characterized by diminished bone formation, while certain investigations have additionally demonstrated enhanced bone resorption. The development of OP has been associated with the extent of hepatic fibrosis, advancing age, and the duration of cholestatic conditions. Dual-energy X-ray absorptiometry remains a widely utilized diagnostic modality for OP detection and should be implemented across all patients with PBC. Regarding therapeutic management, VD and calcium supplementation constitute the fundamental approach for OP prevention. Bisphosphonates may demonstrate efficacy in enhancing patients’ BMD and mitigating fracture risk; however, robust evidence-based medical data remain necessary for confirmation. The therapeutic effectiveness of novel agents such as denosumab and romosozumab in managing OP among PBC populations requires additional comprehensive evaluation.
Credit
Ying Han, Changcun Guo, Jiaqi Yang, Shuhao Su
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CC BY-NC