TBA (24W117)

Bone mineral density status in patients with cirrhosis and estimated risk of major osteoporotic fractures

Author(s)

S. Hunter, E. Jonckheere, C O’Connor, D Noone, P Dillon, L Stobie, A Ruxton, M Blount, J. Ryan

Department(s)/Institutions

Hepatology Unit, Beaumont Hospital, Dublin.

Introduction

Advanced liver disease is a recognised risk factor for osteoporosis. Recent BSG Guidelines on outpatient management of cirrhosis include fracture risk assessment.

Aims/Background

To assess bone mineral density in cirrhosis patients attending the Hepatology Unit, and to determine major osteoporotic risk using the FRAX screening tool in those with biometric data.

Method

The NIMIS database was interrogated for previous DEXA scans, and for radiological evidence of previous likely osteoporotic fractures. Of a subset with available data, the FRAX score was used to calculate 10-year major osteoporotic fracture risk; results were categorised as per NOGG (National Osteoporotic Guidelines Group) guidelines. This was a registered audit (CA2024/196).

Results

DEXA and likely osteoporotic fracture results were gathered in 519 patients. 12.3% had prior DEXA scans. Out of these, 31% had normal bone mineral density, 46.9% were osteopenic and 21.8% were osteoporotic. 14.6% out of the 519 patients had had a likely previous osteoporotic fracture. Based on FRAX scores in 81 patients, 53.1% were classified as low risk, 40.7% intermediate risk (need DEXA scan), 4.9% high risk (treatment should commence) and 1.2% very high risk (osteoporosis specialist referral).

Conclusions

Although cirrhosis is a risk factor for osteoporosis, only 12% of this cohort had DEXA scans, while 15% had evidence of likely osteoporotic fractures. Of those evaluated, approximately half of patients were in the intermediate/high risk categories for osteoporotic fractures. These findings highlight the need for systematic screening and treatment of bone health in patients with advanced liver disease.