Guidelines on the management of osteoporosis associated with chronic liver disease.

1.0 BACKGROUND AND SCOPE OF GUIDELINES An important complication of chronic liver disease is osteodystrophy which includes osteoporosis and the much rarer osteomalacia. Both conditions are associated with significant morbidity through fractures resulting in pain, deformity, and immobility. There is also a further significant increase in the risk of fractures following liver transplantation for end stage chronic liver disease. Osteoporosis is defined as a “progressive systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture” (World Health Organisation, 1994). Common fractures are vertebral compression fractures, fractures of the distal radius, and proximal femur. Although guidelines on the prevention and management of osteoporosis, and specifically corticosteroid induced osteoporosis and osteoporosis in men, have recently been published, there is no consensus on how to manage osteoporosis in patients with chronic liver disease. The scope of these guidelines is to review the assessment and diagnosis of osteoporosis, the therapeutic agents available, and the way in which they can be used in patients with chronic liver disease to prevent osteoporosis with the aim of reducing fracture rate. A number of research priorities have also been identified.