{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T06:11:51Z","timestamp":1775369511070,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,8,28]],"date-time":"2017-08-28T00:00:00Z","timestamp":1503878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>It remains unclear whether primary biliary cholangitis (PBC) represents a risk factor for secondary osteoporosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A case\u2013control study was conducted to examine bone mineral density and bone turnover markers in middle\u2010aged postmenopausal PBC patients without liver cirrhosis. We compared the incidence of low bone mineral density between propensity\u2010score matched subgroups of PBC patients and healthy controls and investigated the mechanisms underlying unbalanced bone turnover in terms of the associations between bone turnover markers and PBC\u2010specific histological findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>Our analysis included 128 consecutive PBC patients, all postmenopausal women aged in their 50s or 60s, without liver cirrhosis or fragility fracture at the time of PBC diagnosis. The prevalence of osteoporosis was significantly higher in the PBC group than in the control group (26% <jats:italic>vs<\/jats:italic> 10%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.015, the Fisher exact probability test). In most PBC patients (95%), the level of bone\u2010specific alkaline phosphatase was above the normal range, indicating increased bone formation. On the other hand, the urine type I collagen\u2010cross\u2010linked N\u2010telopeptide showed variable levels among our PBC patients, indicating unbalanced bone resorption. Advanced fibrosis was associated with low bone turnover. Lobular cholestasis, evaluated as aberrant keratin 7 expression in hepatocytes, showed significant negative correlations with bone formation and resorption, indicating low bone turnover.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results show that, compared with healthy controls, even non\u2010cirrhotic PBC patients have significantly higher risk of osteoporosis. Moreover, lobular cholestasis was associated with low bone turnover, suggesting this feature of PBC may itself cause secondary osteoporosis in PBC patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.13746","type":"journal-article","created":{"date-parts":[[2017,1,23]],"date-time":"2017-01-23T23:16:39Z","timestamp":1485213399000},"page":"1611-1616","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Risk of secondary osteoporosis due to lobular cholestasis in non\u2010cirrhotic primary biliary cholangitis"],"prefix":"10.1111","volume":"32","author":[{"given":"Anna","family":"Seki","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fusao","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Miyatake","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Hiroshima City Hospital  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Takaguchi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kagawa Prefectural Central Hospital  Takamatsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shosaku","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Ritsurin General Hospital  Takamatsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiya","family":"Osawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Okayama Saiseikai General Hospital  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin\u2010ichi","family":"Fujioka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Okayama Saiseikai General Hospital  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryoji","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Okayama Saiseikai General Hospital  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaharu","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mitoyo General Hospital  Kanonji Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Seki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhide","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Okayama Saiseikai General Hospital  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2006.06.007"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20866"},{"key":"e_1_2_6_4_1","first-page":"1356","article-title":"Factors influencing the development of metabolic bone disease in primary biliary cirrhosis","volume":"85","author":"Gua\u00f1abens N","year":"1990","journal-title":"Am. 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