Introduction Cirrhosis is an independent risk factor for osteoporosis, with risk of morbidity through fragility fractures. BSG guidelines recommend that all patients with cirrhosis should be offered DEXA scans to measure bone mineral density (BMD), and receive appropriate treatment. The FRAX score is a widely used internet-based algorithm that predicts fracture risk, which can be calculated with or without BMD data. The aim of this study was to determine if the FRAX score without BMD is effective in predicting fracture risk in patients with cirrhosis to potentially reduce the need for BMD testing.
Methods Between Nov 11 and Jan 12 consecutive patients with cirrhosis who were reviewed in 3 sub-specialist liver clinics (ALD, NASH and HCV) at the Freeman Hospital were included. Clinical and demographic patient information was collected retrospectively. FRAX scores were calculated with and without BMD data.
Results 146 patients (46 NASH, 50 ALD and 50 HCV) were studied (mean age 59±12, 68% male, mean BMI 30±6). 91 patients had BMD assessed (9 [10%] were osteoporotic and 43 [47%] were osteopenic at the spine and/or hip). 10 (6.8%) had a previous osteoporotic fracture. The pre-BMD FRAX score categorised fracture risk as high in no patients, intermediate in 26 (18%) and low in 120 (82%). Overall, 11 (18%) were categorised as high risk with the post-BMD FRAX. 9 patients (10%) moved from a low risk with pre-BMD FRAX to a high risk with post BMD FRAX. In addition 2 (3%) moved from intermediate to high with post-BMD FRAX. Only 5 of 9 (55%) of patients with osteoporosis on BMD were classified as high risk with post BMD FRAX score. There were no significant differences in fracture risk or BMD between patients with ALD, NASH or HCV.
Conclusion The pre-BMD FRAX score underestimates fracture risk in patients with cirrhosis. Therefore, assessment of BMD should continue to form part of the assessment of fracture risk in patients with cirrhosis. As the post-BMD FRAX score includes other risk factors for fracture in addition to bone density it might be the most appropriate to determine which patients require treatment to prevent fractures.
Disclosure of Interest None Declared.
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