Patients with primary sclerosing cholangitis (PSC) may develop reduced bone mineral density. This protocol addresses the specific situation of PSC complicated by osteopenia or osteoporosis as measured by DEXA.

Clinical scenario

PSC in a patient with osteopenia (T-score between −1 and −2.5 SD on DEXA) or osteoporosis (T-score less than −2.5 SD). Per WHO definitions, T-scores are derived from measurement at the femoral neck or the lowest value from either the lumbar spine or femoral neck.

Treatment approach — partial overview

Management targets bone health through a combination of nutritional measures and pharmacological intervention. Supplementation is considered where a specific deficiency is identified, and preventive pharmacological therapy is guided by the individual patient's fracture risk. The complete structured regimen — including selection criteria, sequencing, and full clinical decision points — is available in the protocol below.

References

According to the World Health Organization, osteopenia is defined as a T-score between −1 and −2.5 SD as measured by DEXA, and osteoporosis by a T-score less than −2.5, derived from measurement at the femoral neck or the lowest value from either the lumbar spine or femoral neck.
Although data is lacking, supplementation of vitamin D in case of deficiency seems advisable and sufficient dietary intake of calcium and exercise should be advised according to current guidelines.
Individual fracture risk should guide preventive and therapeutic recommendations, such as the use of bisphosphonates.

DOI: 10.1016/j.jhep.2022.05.011

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Treatment of PSC with Osteopenia or Osteoporosis

References