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General liver II
PWE-277 Fracture prevalence and vitamin D status in primary biliary cirrhosis: the Leicestershire experience
  1. R Krishnamoorthy1,
  2. A Grant2,
  3. P Sheldon3,
  4. T Delahooke2
  1. 1Digestive Diseases Centre, University Hospitals Leicester NHS Trust, Leicester, UK
  2. 2Department of Hepatology, University Hospitals Leicester NHS Trust, Leicester, UK
  3. 3Department of Rheumatology, University Hospitals Leicester NHS Trust, Leicester, UK

Abstract

Introduction Metabolic bone disease is a recognised complication in Primary Biliary Cirrhosis (PBC) and increases the risk of developing fractures. Although osteoporosis is the major contributor, Vitamin D (25- hydroxy- vitamin- D3) deficiency due to fat-soluble vitamin malabsorption is also a contributing factor for bone disease in PBC. Our objective was to assess the prevalence of fractures and vitamin D deficiency in PBC patients.

Methods Patients with diagnosed with PBC between the years 1994 and 2011 were retrospectively identified from the hepatology outpatients. Fracture data were collected from the x-ray reports in the radiology software. Biochemical data including AMA titres and Vitamin D status were retrospectively identified and entered using the pathology database. The grading for Vitamin D levels were as follows: severely deficient- 20 mg/l or >50 nmol/l. Available Bone Mineral Density (BMD) data in patients who had a Dual-emission x-ray absorptiometry (DEXA) scan was studied.

Results Among 209 patients (179 female, median age 68 years, 168 AMA positive with median AMA titre of 1 in 256) with PBC, 27 patients (12.9%, 25 females, median age 74) had sustained a fracture during their clinical course. 33 fracture episodes were identified. Femur/hip fractures were the commonest (9/33, 27%), followed by hand (5/33, 15%). DEXA scans were performed in 39 patients, with a median T score of −2.2. Vitamin D levels were available in 91 patients (44%), the levels being adequate in only 27 patients (29.6%), reflecting the magnitude of the Vitamin D status. 38 patients were insufficient (41.7%), 17 were deficient (18.6%) and 9 were severely deficient (0.09%).

Conclusion Fracture prevalence and vitamin D deficiency is high in PBC patients. Assessing Vitamin D status is a useful measure to improve bone health and reduce the burden of metabolic bone disease.

Competing interests None declared.

Reference 1. Solaymani-Dodaran M, Card TR, Aithal GP, et al. Fracture risk in people with primary biliary cirrhosis: a population-based cohort study. Gastroenterology 2006;131:1752.

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