Primary Biliary Cirrhosis (PBC) (cont.)

Osteoporosis

Whether the usually recommended therapies for osteoporosis can satisfactorily treat or prevent osteoporosis in patients with PBC is not yet clear. It makes good sense, however, to provide adequate calcium and vitamin D in the diet. The vitamin D is needed for absorption of calcium from the gut. Adequate amounts of calcium can be taken by eating dairy products such as milk or yogurt or by supplementing the diet with 1000 to 1500 mg of calcium carbonate. Calcium carbonate, prepared from powdered oyster shells, can be purchased over the counter. Usually, the extra vitamin D contained in a daily multivitamin is enough to satisfy the daily requirement. Exposure of the skin to sunlight also increases the production of vitamin D in the body.

For postmenopausal women with PBC, hormonal replacement therapy with estrogen can decrease the risk of osteoporosis. Estrogen, available in oral form or as a patch that allows absorption of estrogen through the skin, is safe for women with PBC. Remember, however, that there is controversy about the use of estrogen replacement therapy in postmenopausal women who have had breast cancer, because of a possible risk of recurrence of the cancer. There is also concern about prolonged use of estrogens with progestin in incrasing the risk of coronary heart diseases, strokes, and pulmonary embolism in healthy menopausal women. Therefore, whether to use estrogen or not should be individualized after consulting one's doctor. Another alternative to estrogen to protect bone density in patients with PBC is the bisphosphonates, which are FDA-approved drugs for the prevention of osteoporosis. Too few studies have been performed using other drugs (for example, fluoride or calcitonin) for osteoporosis to recommend their use in PBC.


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