Bone health in patients with cirrhosis

Cirrhosis causes bone loss and leads to osteoporosis in approximately 30% of patients. In addition, osteomalacia from poor bone mineralisation may be seen in patients with cholestatic liver disease who have vitamin D deficiency. Bone densitometry using dual-energy X-ray absorptiometry (DXA) should be performed every 2 years in all patients with cirrhosis.

Vitamin D should be supplemented as required to maintain serum concentrations within the normal range; see Vitamin D deficiency.

For management of osteopenia (T-score –1.5 to –2.4) or osteoporosis (T-score –2.5 or lower), see Osteoporosis and minimal-trauma fracture.