Introduction Osteodystrophy is a recognised complication with cirrhosis. Female sex, cholestasis, low BMI are proven to increase risk of bone disease in cirrhotics1,2. Our aim is to audit our current practise of diagnosis and management of osteoporosis in liver patients and to identify other associated risk factors.
Methods Retrospective audit was done on 73 cirrhotic patients enrolled in the Hepatocellular Carcinoma (HCC) surveillance programme in our hospital. Our practise was compared with British Society of Gastroenterology (BSG) recommendations2. Data on demographics, aetiology of cirrhosis, alcohol or steroid intake, post menopausal state, presence of varices, investigations for osteoporosis done and treatment given were collected and analysed.
Results Only 34 patients had DEXA scan performed at any point, with average duration between cirrhosis diagnosis and first scan being 2.41 years. 14 had osteoporosis (T score < –2.5) at hip or lumbar spine and 11 were osteopenic (T of –1.5 to –2.5), showing a prevalence of bone disease at 73.5%. On analysis, except for female sex, no other variable increased risk of bone disease. Few patients were tested for Vitamin D (6.8%) or hormonal studies (8.1%) but 78% had thyroid tests and 100% had bone profile. Treatment for osteoporosis was given, as recommended in all subjects; however 2-yearly follow up scans happened only in 19.2%. Though 6/11 patients had varices, association was not statistically significant by Pearson chi-square test (p value of 0.058). Similarly, longer duration of cirrhosis did not increase risk as analysed by t-test.
Conclusion Our audit showed high prevalence of bone disease (osteoporosis and osteopenia) in chronic liver disease patients, however there is bias as DEXA scans were requested only in symptomatic patients. There was poor compliance with BSG guideline especially with surveillance intervals. Female sex increases risk but the association of bone disease with duration of cirrhosis and presence of varices are not statistically significant.
Disclosure of Interest None Declared
Wariaghli G, Mounach A, Achemlal M, et al. Osteoporosis in chronic liver disease: a case control study. Rheumatology International 2010 May; 30(7):893–92.
Collier JD, Ninkovic M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut 2002; 50 (Suppl 1):i1-i9