Liver Health and Osteoporosis

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Jan 21st, 2009

Medical workers have consistently observed a higher percentage of osteoporosis in people with chronic liver disease. By understanding the connection between these two illnesses, anyone can positively influence both liver and bone health by instituting several lifestyle changes.

People living with chronic liver disease have an additional reason to be concerned about osteoporosis. According to physician reports, anywhere between 20 and 100 percent of people with chronic liver disease have some level of osteoporosis. So far, scientists have been unable to uncover the exact reason for this connection and agree that many factors likely contribute to bone loss with liver disease. Although the causative reason for this connection remains unclear, improving liver health has been observed to positively affect bone health.

Osteoporosis
Characterized by low bone mass and structural deterioration of bone tissue, osteoporosis is a disease in which bones become fragile and are more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. Typically occurring in the hip, spine and wrist, osteoporosis-related bone fractures may require hospitalization and major surgery. Osteoporosis can result in a loss of height, cause severe back pain and deformity, impair a person’s ability to walk unassisted, may cause prolonged or permanent disability or even lead to death.

A major public health threat for an estimated 44 million Americans, osteoporosis is reported in people of all ethnicities. Of those struggling with decreasing bone mass, about 80 percent are women and 20 percent are men. While osteoporosis is often thought of as an older person’s disease, it can strike at any age.

Possible Bone and Liver Links
Osteoporosis is a well-known and frequently reported complication of chronic liver
disease – especially following a liver transplant. Although a combination of reasons is likely responsible for this complication, below are several likely contributors:

· Corticosteriods – Known to weaken the bones, corticosteroid therapy is the primary therapy for autoimmune hepatitis and immunosuppression after liver transplantation.

· Hormone Changes – The liver is intimately involved with hormone manufacture and release. The decline in hormones such as estrogen is an established risk factor for osteoporosis.

· Vitamin D Deficiency – Vitamin D is required for creating and maintaining bone strength. Various studies have reported that people with chronic liver disease have lower detectable levels of vitamin D than healthy controls.

· Osteoprotegerin – Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor family, has recently been found to regulate bone turnover. Produced by the liver, OPG exhibits a relationship with healthy bone growth. Scientists speculate that a decline in liver function may be associated with reduced production of OPG, thereby contributing to lower bone density.

Osteoporosis Risks
Certain people are more likely to develop osteoporosis than others. Seventeen known risk factors increasing the likelihood of developing osteoporosis and fractures include:

1. History of fracture after age 50
2. Current low bone mass
3. History of fracture in a close relative
4. Being thin and/or having a small frame
5. Advanced age
6. A family history of osteoporosis
7. Estrogen deficiency as a result of menopause, especially early or surgically induced
8. Abnormal absence of menstrual periods (amenorrhea)
9. Anorexia nervosa
10. Low lifetime calcium intake
11. Vitamin D deficiency
12. Use of certain medications (corticosteroids, chemotherapy, anticonvulsants and others)
13. Presence of certain chronic medical conditions including liver disease
14. Low testosterone levels in men
15. An inactive lifestyle
16. Current cigarette smoking
17. Excessive use of alcohol

Osteoporosis Prevention
Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. When united, the following six suggestions can optimize bone health and help prevent osteoporosis:

1. Eating a balanced diet rich in calcium and vitamin D
2. Taking a well-formulated supplement to support bone health
3. Doing weight-bearing and resistance-training exercises regularly
4. Avoiding unhealthy lifestyle choices such as smoking or excessive alcohol intake
5. Communicating with your healthcare professional about bone health
6. Being tested for bone density and taking medication when appropriate

Liver Health
Since researchers have demonstrated that the severity of a person’s liver disease is directly proportional to a decrease in bone mass, the reverse must also be true. In addition to taking steps for preventing osteoporosis, maintaining liver health also positively impacts bone health. Luckily, many of the suggestions for preventing osteoporosis also apply to preserving liver health such as:

1. Eating a diet low in processed foods, saturated fat and simple sugars while indulging in lean protein, fruits, vegetables and high-fiber options
2. Supplementing with a proven supporter of liver health, such as Maximum Milk Thistle
3. Incorporating regular exercise into every day
4. Avoiding all alcohol, drugs and tobacco products
5. Working with your physician and taking medications as necessary
6. Taking preventative measures such as getting Hepatitis A and B vaccinations to prevent compounding liver disease

Since the medical community recognizes that bone health and liver health are connected, improvements can be made in either area by making some simple choices. When it comes to improving the length and quality of life – diet, exercise, herbal supplements and other healthy habits are much simpler than managing the complications brought on by worsening illness. Especially important for a person living with chronic liver disease who has several osteoporosis risk factors, making several conscious lifestyle adjustments can help keep your liver function stable and keep your bones strong.

References

Henkel, Anne S, Alan L Buchman, Nutritional Support in Chronic Liver Disease, Nature Clinical Practice Gastroenterology & Hepatology, April 2006.

Ninkovic, M, et al., High prevalence of osteoporosis in patients with chronic liver disease prior to liver transplantation, Calcified Tissue International, December 2001.

Ormarsdottir, Sif, Osteoporosis in Chronic Liver Disease, Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 2001.

www.natap.org, Bone Loss in Liver Disease, Hepatic Osteodystrophy, Hepatology, January 2001.

www.nof.org, What is Osteoporosis?, National Osteoporosis Foundation, 2007.

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Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.