Patients with liver disease may develop an osteodystrophy that features a combination of both osteoporosis and osteomalacia. Together the patient develops a decrease in bone density.
Patients at risk:
(1) later stages of primary biliary cirrhosis
(2) later stages of sclerosing cholangitis
(3) other cholestatic liver diseases
Clinical features with osteoporosis (secondary to decreased osteoblastic activity):
(1) back pain
(2) vertebral collapse with kyphosis
Clinical features with osteomalacia:
(1) bone pain
(2) bone tenderness on palpation
(3) fractures and pseudofractures
(4) proximal muscle weakness
Vitamin D deficiency:
(1) poor absorption
(2) poor dietary intake
(3) reduced sunlight exposure
(4) reduced serum carrier protein for 25-hydroxy vitamin D3
(5) medications
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