From the Guidelines
Trabecular bone disease, also known as osteoporosis, should be diagnosed using bone mineral density (BMD) measurements, and treatment should include a balanced diet, supplements of calcium and vitamin D, and pharmacological therapies such as bisphosphonates to reduce the risk of fractures. The diagnosis of osteoporosis is based on BMD measurements, which can be performed using DEXA scans, and the World Health Organization defines osteoporosis as a BMD that is 2.5 standard deviations below the young average value (T-score < 2.5) 1.
Diagnosis
The diagnosis of osteoporosis in patients with chronic liver disease is crucial to prevent fractures and improve quality of life. According to the study by 1, bone densitometry of the lumbar spine and hip is the gold standard procedure for the diagnosis of osteoporosis and osteopenia. Laboratory measurements to identify abnormal calcium and vitamin D metabolism are also appropriate, and biochemical markers of bone turnover can be determined to monitor the response to therapy.
Treatment
The treatment of osteoporosis in patients with chronic liver disease should include a balanced diet, supplements of calcium (1,000–1,500 mg/d) and 25-hydroxy-vitamin D (400–800 IU/d or 260 μg every 2 weeks), and pharmacological therapies such as bisphosphonates 1. Bisphosphonates, such as etidronate, alendronate, and ibandronate, have been shown to increase bone mass and reduce the incidence of fractures in patients with primary biliary cholangitis (PBC) and other causes of osteoporosis.
Pharmacological Therapies
Some key points to consider when treating trabecular bone disease include:
- Bisphosphonates are anti-catabolic drugs that increase bone mass and reduce the incidence of fractures in postmenopausal osteoporosis, and their effects in chronic liver disease are similar to those in other causes of osteoporosis 1.
- Hormonal replacement therapy, such as transdermal oestrogens, can prevent bone loss or even increase BMD in patients with PBC or autoimmune cirrhosis and in postmenopausal women after liver transplantation, with no liver adverse effects 1.
- Anabolic drugs, such as PTH 1–34, and denosumab, a human monoclonal IgG antibody that binds to RANKL and inhibits bone resorption, may be potential therapies for osteoporosis in patients with liver disease, but more studies are needed to confirm their efficacy 1.
Lifestyle Modifications
Lifestyle modifications, such as physical activity, particularly exercises designed to improve the mechanics of the spine, and discontinuation of alcohol and tobacco use, are also important in reducing the risk of fractures and improving bone health in patients with chronic liver disease 1.
Monitoring
Regular monitoring of BMD and biochemical markers of bone turnover is essential to assess the response to therapy and adjust treatment as needed. According to the study by 1, bone densitometry should be evaluated in patients with previous fragility fractures, those treated with corticosteroids, and before liver transplantation, and needs to be assessed in patients with cholestatic diseases or if any of the described risk factors are found, and in cirrhotics.
From the Research
Diagnosis and Treatment of Trabecular (TRAB) Bone Disease
There are no research papers provided that directly discuss the diagnosis and treatment of Trabecular (TRAB) bone disease. The studies provided are related to thyroid diseases, such as Graves' disease and chronic autoimmune thyroiditis, and glaucoma.
Related Studies
- The studies 2, 3, 4, 5 discuss the role of TSH receptor antibodies (TRAb) in thyroid diseases, including Graves' disease and chronic autoimmune thyroiditis.
- Study 6 discusses the effect of phacoemulsification after trabeculectomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma, but does not provide information on Trabecular bone disease.
Key Findings
- The studies provided do not discuss Trabecular bone disease, but rather focus on thyroid diseases and glaucoma.
- There is no information available on the diagnosis and treatment of Trabecular bone disease based on the provided studies.
Relevant Information
- Trabecular bone is a type of spongy bone tissue that is found in the ends of long bones and is important for bone health.
- However, without specific studies on Trabecular bone disease, it is not possible to provide information on its diagnosis and treatment based on the provided evidence.