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Hepatic osteodystrophy is a frequent late complication in chronic liver diseases in which patients usually present bone mineral density reduction, osteopenia, osteoporosis and fractures. Strategies to decrease incidence, avoid comorbidity and improve patient quality of life have yet to be implemented in clinical practice. Hepatic osteodystrophy's pathophysiology is poorly understood. There is controversy about the use of screening tests especially regarding which patients are eligible, at what moment of the disease and with what frequency. Risk factors which are dependent on liver disease and other risk factors which are not liver disease dependent have been identified, all of which affect the natural history of hepatic osteodystrophy and all of which must be taken into account for screening, checkups and treatment. Recommendations for treatment are widely discussed but focus mainly on reduction of risk factors, antiresorptive drugs, calcium supplements and vitamin D. [ABSTRACT FROM AUTHOR]

Coagulation alterations in patients with chronic liver disease occur frequently, although they are usually described as auto-anticoagulation phenomena. Changes in hemostasis are broad and diffuse. They include changes in procoagulant and anticoagulant substances, hemodynamic modifi cations, endothelial dysfunction and platelet malfunction which are the causes of different clinical conditions varying from hemorrhaging to thrombosis. Given the complexity of theses alterations, laboratory tests do not correlate well with the clinical events. Treatment for these patients has been controversial. Currently we do not have objective methods for determining the hemostatic balance between bleeding and thrombosis in patients with chronic liver disease. In addition to this, the medical literature does not include guidelines for dealing with this special population. Also, the risk of thrombosis indicates the need to consider the use of thromboprophylaxis. [ABSTRACT FROM AUTHOR]