Ryder also strongly recommends a bone density test when you are first diagnosed with pbc and said he tests all his patients for bone thinning and monitors regularly. If you are diagnosed before menopause you should be checked again at the onset of the menopause. If you are in doubt about having started the menopause a blood test will confirm this. Calcium is recommended for those only on a restrictive diet, ie vegetarians, he thinks that a balanced diet is sufficient. He recommends only taking calcium if there is evidence of bone thinning.
Steroids can increase bone thinning but in certain cases are beneficial to pbc.
Extra fluoride is not recommended for this same reason. After fluoride treatment the bones will look thicker on x-ray, but are actually thinner. Ok in toothpaste but not as extra in tablets etc. Calcitonin, a bone building element only makes a marginal difference and there are side-effects. This treatment is given over 2-3 years and can be repeated.