Bone Health Recommendations

Introduction to Bone Health Guidelines

The European Association for the Study of the Liver (EASL) recommends calcium supplementation of 1,000-1,500 mg/day for bone health 1, 2, 3, 4
The American Society of Clinical Oncology (ASCO) suggests vitamin D supplementation of 400-800 IU/day for bone health 5
The European League Against Rheumatism (EULAR) recommends weight-bearing exercise and resistance training for bone health 6
The British Society of Gastroenterology recommends smoking cessation and alcohol limitation for bone health 7
The American Association for the Study of Liver Diseases recommends bisphosphonates (alendronate, risedronate) for T-scores ≤-2.5 or after pathological fracture 8

Calcium supplementation of 1,000-1,500 mg/day is recommended for bone health by the EASL 3, 4, 8
Vitamin D supplementation of 400-800 IU/day is recommended for bone health by the ASCO and EASL 5, 3, 4, 7, 8
Bisphosphonates (alendronate, risedronate) are recommended for T-scores ≤-2.5 or after pathological fracture by the EASL and ASCO 1, 5, 2, 4
Weight-bearing exercise and resistance training are recommended for bone health by the EULAR and ASCO 5, 6
Smoking cessation and alcohol limitation are recommended for bone health by the ASCO, EASL, and British Society of Gastroenterology 5, 3, 7

Patients with chronic liver disease should focus on proven interventions: calcium (1,000-1,500 mg/day) and vitamin D (400-800 IU/day) supplementation, as recommended by the EASL and American Association for the Study of Liver Diseases 3, 8
Bone densitometry should be performed in patients with liver disease, especially those with cholestatic conditions, before transplantation, or on corticosteroids, as recommended by the EASL and American Association for the Study of Liver Diseases 3, 8
Patients receiving corticosteroids should receive 800-1,000 mg/day calcium and 800 IU/day vitamin D, as recommended by the British Society of Gastroenterology 7
High-risk patients should start bisphosphonate therapy at the onset of corticosteroid treatment, as recommended by the British Society of Gastroenterology 7