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A Journal on Internal Medicine

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Panminerva Medica 2002 December;44(4):335-41

language: English

Osteoporosis in primary biliary cirrhosis

Newton J., Jones D.

Centre for Liver Research, University of Newcastle, Newcastle, UK


Primary bil­iary cir­rhosis (PBC) is an auto­im­mune ­liver dis­ease ­that is typ­i­cally pro­gres­sive, ­with a sig­nif­i­cant pro­por­tion of ­patients ­going on to ­develop cir­rhosis. It pre­dom­i­nately ­affects ­women and typ­i­cally ­develops in the ­middle ­years of ­life. In ­most cen­tres the ­median age for pres­en­ta­tion is in the ­range 55 to 60 ­years, ­with a sig­nif­i­cant pro­por­tion of ­patients ­first pre­senting ­over the age of 65. Due to ear­lier diag­nosis, PBC has ­gone ­from ­being a ­rare dis­ease, char­ac­ter­ised by the com­pli­ca­tions of end-­stage ­liver dis­ease, to a sig­nif­i­cantly com­moner dis­ease (­affecting up to 1 in 700 ­women ­over the age of 40) diag­nosed ­often in an asymp­to­matic ­stage. Osteoporosis ­increases ­with ­advancing age and ­hence ­there is an ­increased prev­a­lence of oste­o­por­osis in ­older ­people. The ques­tion of ­whether oste­o­por­osis ­occurs as a spe­cific com­pli­ca­tion of PBC has lat­terly ­proved to be con­tro­ver­sial. This ­article ­reviews the cur­rent lit­er­a­ture and exam­ines why dif­fer­ences ­occur in oste­o­por­osis prev­a­lence in the avail­able ­studies. It ­becomes ­clear ­that ­when deter­mining the ­true ­extent of the asso­ci­a­tion ­between oste­o­por­osis and PBC, con­clu­sions ­must be ­drawn ­from ­large pop­u­la­tions, and ­that ­when con­sid­ering a dis­ease ­such as oste­o­por­osis ­that is ­common in ­older ­people, age ­matched ­values be ­used in ­order to ­draw ­these con­clu­sions. As PBC is a dis­ease ­that ­often ­presents for the ­first ­time ­over the age of 65, it is not sur­prising ­that oste­o­por­osis is a ­common ­problem in a dis­ease pre­dom­i­nately ­affecting ­peri- or ­postmen­o­pausal ­women.

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