Chronic liver disease should be alert to osteoporosis!

Osteoporosis is a systemic bone disease characterized by low bone mass and destruction of bone microarchitecture, leading to increased bone fragility and susceptibility to fractures. Studies have found that osteoporosis is one of the common complications of chronic hepatitis B patients. It has been reported that the probability of osteoporosis in patients with chronic hepatitis B is 1.13 times that in people without chronic HBV infection.

How does TCM understand the relationship between liver disease and osteoporosis?

“Su Wen Liujie Zangxiang Lun” says, “The liver is the root of the extreme, the dwelling of the soul, its beauty is in the claws, and it is filled in the tendons to generate blood and qi… .” When the blood of the liver is full, the tendons can be nourished, and when the tendons are nourished, they can move flexibly and powerfully. If the liver is deficient, the blood will be deficient, the muscles and bones will be deficient. “Simple Questions • Meridian Different Treatises” says that “eating qi enters the stomach, dispersing essence in the liver, and lustful qi in the tendons”. “Su Wen • Ancient Innocent Treatise” also mentioned that “if the liver qi is weakened, the tendons cannot move”, and “husband… Seven or eight, the liver qi is weakened, and the tendons cannot move”. If the liver fails to disperse, it will affect the production and operation of qi, blood and body fluids in the human body, thereby affecting the nutrition of muscles and bones.

Let’s take a look at some of the risk factors for osteoporosis:


•Gender, especially postmenopausal white and Asian women

•Slim body

•Family history of osteoporosis

•Premature menopause (under 45)

•Anorexia nervosa or bulimia

•Low calcium diet

•Use of certain medicines, such as corticosteroids and anticonvulsants, some for breast and prostate cancer

•Low testosterone levels in men

•lack of exercise


•Excessive use of alcohol (more than three glasses of wine, beer or liquor per day)

•Other diseases such as bowel problems, kidney problems, hormone problems, kidney stones, liver disease

•Organ transplant recipients

It can be seen that liver disease itself is a risk factor for osteoporosis. In patients with chronic liver disease, due to liver dysfunction, vitamin D3 metabolism will be affected accordingly, followed by calcium malabsorption, and eventually osteopenia and osteoporosis.

Why are patients with chronic liver disease prone to osteoporosis?

Clinically active chronic hepatitis, alcoholic cirrhosis, and primary biliary cirrhosis are the three main chronic liver diseases that cause osteoporosis.

Cirrhosis of the liver and chronic alcoholism of various causes can cause malnutrition osteoporosis such as calcium, magnesium, and protein deficiency.

The causes of osteoporosis in patients with chronic liver disease and cholestasis include malnutrition weight loss, decreased activity, hypogonadism, vitamin A, vitamin D, vitamin K metabolism disorders, osteogenesis Cells are inhibited, and fat and calcium malabsorption caused by bile synthesis and excretion disorders.

Long-term use of the nucleoside antiviral drugs adefovir dipivoxil or tenofovir fumarate may lead to a decrease in bone mineral density, which may be related to the drug-induced failure of renal proximal tubular cells from urine Fluid reabsorption of bicarbonate results in increased urinary bicarbonate and subsequent acidemia.

Medications such as diuretics, quinolones and non-steroidal anti-inflammatory drugs, and proton pump inhibitors that may be used clinically in patients with liver disease may also interfere with bone metabolism.

Hyperbilirubinemia and vitamin K deficiency can lead to impaired bone formation and an increased risk of fractures.

Long-term excessive drinking causes malnutrition and malabsorption, which directly affects bone metabolism, leading to osteoporosis and increasing the incidence of fractures.

Glucocorticoids frequently used in autoimmune liver disease can increase RANKL levels, promote osteoclast formation, inhibit intestinal and renal calcium absorption, and the degree of bone loss is also related to the cumulative dose of glucocorticoids.

What are the symptoms of osteoporosis?

1. Fatigue

It is easy to feel fatigued, and the weight-bearing capacity is reduced or even unable to bear weight;

2. Bone pain

The lower back pain is more common, but it can also occur with systemic bone pain. The pain is mostly diffuse and has no fixed pain points;

3. Spine deformation

Vertebral compression fractures caused by severe osteoporosis can cause spinal deformities such as short height and hunchback;

4. Fragility fractures

Fractures are prone to occur during minor trauma or daily activities, and after a fracture occurs, the chance of refracture increases significantly.

Mechanisms of osteoporosis in chronic liver disease:

(1) Abnormal vitamin D metabolism: Cholestasis and reduced fat intake in patients with chronic liver disease, resulting in reduced absorption of fat-soluble vitamin D. At the same time decreased liver function also affects the synthesis of active vitamin D.

(2) Malabsorption of calcium.

(3) Long-term excessive drinking causes malnutrition, which directly affects bone metabolism, reducing bone formation and bone mineralization, which can lead to osteoporosis over time.

(4) The use of glucocorticoids in patients with autoimmune liver disease will inhibit the formation and activity of osteoblasts, inhibit the synthesis of protein mucopolysaccharides, and cause obstacles to the synthesis of bone matrix, resulting in the appearance of bone Loose quality.

(5) Long-term diuresis in patients with decompensated cirrhosis and ascites results in calcium loss.

(6) Some patients with liver disease have indigestion, which will cause abdominal distension when eating milk, and they are unwilling to drink milk, so the intake of calcium is less.

(7) Decompensated liver disease patients have less outdoor activities and less chance to receive ultraviolet radiation, which also affects the transformation and synthesis of vitamin D.

Osteoporosis Prevention

1. Balanced nutrition, proper calcium supplementation

Ensuring a rich and balanced diet is the basic way of life to prevent osteoporosis.

Eat foods high in calcium and vitamin D, such as vegetables, fish, eggs, tofu, mushrooms, oats, and dairy products.

At the same time, you should also adhere to a low-salt diet, drink plenty of water, and maintain smooth stools to increase appetite and promote calcium absorption.

Pay attention to quit smoking, limit alcohol, and avoid excessive consumption of coffee and carbonated beverages.

2. Promote physical exercise to increase adult bone reserve

Young people’s bones are more sensitive to exercise than older people, so regular exercise, preferably weight-bearing, should begin at age 35 to increase bone mass.

3. Plenty of sunshine

In addition to being derived from food, vitamin D is also synthesized by the skin from the ultraviolet rays of the sun.

Sufficient sunlight, it is recommended to expose the limbs and facial skin to the sun for 15-30 minutes from 11:00 to 15:00, twice a week to promote the synthesis of vitamin D in the body.

Try not to apply sunscreen to avoid affecting the effect of sunlight, but be careful to avoid strong sunlight to avoid burning your skin.

4. Actively treat diseases related to osteoporosis

Such as diabetes, rheumatoid arthritis, steatorrhea, chronic nephritis, hyperparathyroidism, hyperthyroidism, bone metastases, chronic hepatitis, liver cirrhosis, etc.

5. Protect liver and kidney function

Facilitates the formation of active vitamin D and the mineralization of bones.

6. Fracture prevention

The activity place for elderly patients should have better lighting, the floor should be dry to prevent falls, and various measures to prevent falls should be taken.

7. Pay attention to mental health regulation

The impact of osteoporosis on the psychological state of patients is often overlooked, mainly including sleep disorders, anxiety, depression, fear, loss of self-confidence and other psychological abnormalities.