Bone mineral density examination

When the liver does not function properly, important nutrients are not absorbed properly and malabsorption of calcium means that PSCers are susceptible to osteoporosis.  In fact, studies have shown that PSCers can lose bone mass at an average of 1% per year (Angulo et al, 2010)

Bone mass density (BMD) can be measured by having a Dexa scan. Angulo et al (2010) suggest using an initial BMD reading when PSC is diagnosed, and these results (in addition to other risk factors of older age, lower BMI and duration of IBD) used to determine the frequency of follow-up testing to allow for early identification and management of bone disease:

  • All patients - at time of diagnosis of PSC
  • PSCers with normal bone mass and short duration of IBD every 24-36 months
  • PSCers with bone mass in range of osteopenia (especially those with long-lasting IBD) - every 6-12 months

Wiencke and Boberg (2011) also recommend that bone mineral density examination should be carried out when PSC is diagnosed to check for osteopenia or osteoporosis and should be carried out at regular intervals depending on degree of cholestasis and individual risk factors.

A Dexa machine is used to scan the bones in you lower back and hips. You will be asked to lie on a bed and stay still while the scanner, a kind of X-ray machine, moves over the different  parts of your body being scanned. The procedure is painless and will take approximately 15 minutes.

Depending on your results you will be offered dietary advice and treatment. Generally scores of:

  • between 0 and -1 means no action is needed.
  • between -1 and -2.5 means you have osteopenia. This result isn’t serious, but it means your bone density is lower than normal and you may be more likely to develop osteoporosis in the future.
  • below -2.5 means you have osteoporosis, and you will probably be offered treatment by your doctor.

Men need to make sure they are being monitored for osteoporosis, this is not just a female issue.

Dietary supplementation with calcium and vitamin D should be considered in all patients with cholestatic liver disease although this advice is not evidence-based. Bisphosphonates are indicated/suggested in the case of osteoporosis.

Reviewed 10/05/12

Want to know more?

Angulo P, Grandison GA, Fong DG, Keach JC, Lindor KD, Bjornsson E & Koch A., 2011. Bone Disease in Patients With Primary Sclerosing Cholangitis. Gastroenterology,140, pp.80-188 [doi:10.1053/j.gastro.2010.10.014]
Wiencke and Boberg, 2011. Current consensus on the management of primary sclerosing cholangitis. Clinics and Research in Hepatology and Gastroenterology 35:786-791