Why is osteopenia often found in older adults with hepatic disease?

Osteopenia is a condition characterized by lower than normal bone density, which can be particularly prevalent in older adults with hepatic disease due to several interrelated factors.

First, dysmetabolism of calcium and vitamin D plays a crucial role. The liver is vital for the metabolism and activation of vitamin D, which is essential for calcium absorption from the intestines. In individuals with hepatic disease, the impaired liver function can lead to insufficient levels of active vitamin D, causing disturbances in calcium metabolism and ultimately resulting in decreased bone density.

Long-term steroid use, often prescribed for various liver conditions and inflammation, can also contribute to osteopenia. Corticosteroids are known to negatively impact bone health by inhibiting osteoblast function (cells that form new bone) and promoting bone resorption. This can further exacerbate bone loss in older adults who already might have decreased bone density due to age and health conditions.

Additionally, alcohol consumption, which is frequently a factor in hepatic disease, directly affects bone health. Chronic alcohol use can lead to nutritional deficiencies, impair calcium absorption, and disrupt the hormonal regulation of calcium and bone metabolism. It also has a toxic effect on osteoblasts, further decreasing bone formation.

Given these three significant contributors—dysmetabolism