What are the causes of hepatic osteodystrophy?

What are the causes of hepatic osteodystrophy?

1. Hepatic osteodystrophy, especially cirrhosis, is often accompanied by hypoproteinemia, which reduces protein-bound calcium and affects vitamin D transport; liver function declines and 25-OH-D3 production decreases; in hepatic osteodystrophy, loss of appetite, indigestion or gastrointestinal mucosal edema reduce intestinal calcium absorption; long-term ethanol intake in patients with alcoholic cirrhosis stimulates the liver cells to accelerate the degradation of vitamin D and 25-OH-D3, leading to hypocalcemia.

2. Immune cells, especially monocytes and mononuclear macrophages, can synthesize and release osteolytic prostaglandins, mainly PGE and PGF. Lymphocytes can also release osteolytic factors. Another type of prostaglandin comes from the bone itself. Endotoxin can cause bone resorption, stimulate mononuclear macrophages to synthesize prostaglandins, and release calcium.

3. Reduced phosphorus intake and absorption are seen in hunger, malabsorption syndrome, vomiting, hypernutrient therapy, etc. Chronic alcoholism can also cause hypophosphatemia due to nausea, vomiting or refusal to eat. Non-oral hypernutrient therapy, long-term non-phosphate solution, can cause iatrogenic hypophosphatemia.

4. Alcohol can also lead to calcium and magnesium deficiency. Hypocalcemia can stimulate the parathyroid gland to secrete ATP and increase bone absorption. Magnesium deficiency is often accompanied by hypocalcemia, leading to osteoporosis. Osteoporosis also occurs in chronic severe hepatitis, lupus hepatitis and toxic hepatic osteodystrophy.