Osteoporosis

Liver disease increases your risk of bone thinning. Your doctor will monitor this with Dexa scans, which give a ‘T score’. Healthy bones have a T score of 1. If you have a T score of between -1 and -2.5, you have minor bone thinning. Doctors call this osteopenia (pronounced ost-ee-oh-peen-ee-ah). Your doctor will just keep an eye on this.

A T score of less than -2.5 means you have more severe bone thinning that increases your risk of fracture. This is osteoporosis. Women are more at risk of osteoporosis than men, particularly after the menopause.

If your bone density scan shows that your bones are thinner than they should be, your doctor may suggest treatment with a medicine called a bisphosphonate. This helps to reverse the loss of calcium and strengthen your bones. They will also suggest that you take daily calcium and vitamin D tablets.

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Thyroid disease

Around 1 in 4 people with PBC have autoimmune thyroid disease. This causes an underactive thyroid, so the levels of thyroid hormones circulating in your blood are lower than they should be.

Having low levels of thyroid hormones can make your fatigue worse. If blood tests show your thyroid hormones are low, your doctor will prescribe tablets to bring your levels back up to normal.

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Diabetes

People with PBC may have a greater chance of developing diabetes. Your doctor will monitor this with a long-term glucose blood test called HbA1c. If you do develop diabetes, your doctor may prescribe tablets  or in some cases insulin injections to help control your blood sugar. You can find a wealth of information on diabetes and its treatment on the Diabetes UK website.

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High blood cholesterol

Although people with PBC can develop higher than normal blood cholesterol levels, it’s usually the ‘good’ cholesterol level that’s raised. If so, this does not necessarily increase your risk of heart disease. But some people have more generally raised cholesterol. If this is the case, or if you have other risk factors for heart disease, your doctor may suggest tablets called statins.

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Other autoimmune conditions

The commonest autoimmune disease linked to PBC is called Sjogren’s syndrome. Around 1 in 3 people with PBC develop this. It commonly causes dry eyes and a dry mouth (these symptoms are sometimes known as ‘sicca complex’). Some people also develop vaginal dryness and difficulty swallowing from lack of saliva. Your doctor may prescribe eye drops, artificial saliva or a vaginal moisturiser. If you have dry eyes or a dry mouth, you should have regular eye or dental check ups as these can cause other problems. There is more information about Sjogren’s syndrome on the NHS website.

Around 1 in 4 people (25%) with PBC develop an autoimmune condition called Raynaud’s disease. The smallest blood vessels in your fingers and toes close up in the cold, causing your fingers or toes to turn white.  They may then turn blue or red. It can be painful when the circulation returns. If Raynaud’s is mild, you may be able to control your symptoms by not letting your hands or feet get too cold – always wearing gloves in cold weather for instance. If more severe, your doctor may prescribe tablets to help.  There is more information about Raynaud’s on the NHS website.

About 1 in 12 people (8%) with PBC develop scleroderma. This is an autoimmune condition that affects the skin. It has a wide range of possible symptoms. It can also cause Raynaud’s, as well as thickened skin, indigestion and difficulty swallowing. Your doctor will treat any symptoms you have. There is more information about scleroderma on the NHS website.

Up to 1 in 8 people (12%) with PBC develop coeliac disease. This causes an allergic reaction to a wheat protein called gluten. You have abdominal pain, bloating and diarrhoea when you eat any foods containing wheat. If you develop coeliac disease, you will have to eat a gluten free diet. There is more information about coeliac disease on the NHS website.

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Advanced liver disease

If your PBC becomes advanced, it will cause more generalised liver damage, called cirrhosis. Although this sounds more serious, people can and do live for many years with cirrhosis. There is information about the treatment of advanced PBC and cirrhosis of the liver in the page on Treating advanced primary biliary cirrhosis

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