Mineral disorders in patients with chronic liver disease. Part 1: epidemiology and pathophysiology

Chronic liver disease is a significant public health problem worldwide, and its consequences lead to the development of various mineral disorders, which occur in 75% of patients. Osteoporosis (up to 30% of patients) has the greatest clinical significance among the mineral disorders that develop in chronic liver disease. Fractures occur, according to different data, in 7-35% of patients. There are number of mechanisms influencing the state of mineral metabolism in chronic liver diseases: from the disturbance of vitamin D metabolism to the synthesis of pro-inflammatory cytokines and the function of intestinal microbiota. To date, these processes remain insufficiently studied: for example, aspects concerning the functioning of parathyroid glands in chronic liver diseases are not completely clear; there is no clear idea about the predominant processes in bone tissue (anti- or proresorptive). This determines the imperfection of prophylactic and therapeutic approaches in mineral disorders due to chronic liver diseases and the need for further research in this direction. The first part of this review focuses on the epidemiology and pathophysiology of mineral metabolism disorders in these conditions; the second part of the review will focus on current therapeutic approaches