Introduction Current British Society of Gastroenterology guidelines recommend DEXA scanning all patients with cirrhosis. All patients with a diagnosis of cirrhosis attending the cirrhosis clinic at Aberdeen Royal Infirmary are referred for DEXA scanning. We aimed to establish whether a risk stratification strategy using a fracture risk calculation tool (FRAX) to determine which patients should receive a DEXA scan is effective in reducing scan rates without compromising sensitivity for detecting osteoporosis.
Method A retrospective analysis of 282 patients with liver cirrhosis undergoing hepatoma screening in Aberdeen Royal Infirmary. Receiver operating characteristic (ROC) analyses were performed to assess sensitivity and specificity of FRAX calculated 10-year fracture risk thresholds of 5%, 10% and 15%.
Results DEXA scan results were available for 205 patients. Mean age was 61.2(±9.1) years, of which 58.0% were male. Cirrhosis aetiology was largely a result of alcohol excess (n = 68), hepatitis C infection (n = 47) and non-alcoholic fatty liver disease (n = 34). The majority of patients were in good prognostic groups (88.8% Child-Pugh A, 10.7% Child-Pugh B, 0.5% Child-Pugh C). The prevalence of osteoporosis was 18.0% consistent with existing literature. The optimum FRAX 10-year fracture threshold was found to be 10%. This retained a high sensitivity of 96.2%, specificity 63.1%, and negative predictive value 98.1%. DEXA scanning rates would have been reduced from 100% (current policy) to 47.3%.
Conclusion A risk stratification strategy for diagnosing osteoporosis using a fracture risk assessment tool (FRAX) and 10-year fracture risk threshold of 10% has high sensitivity for detecting osteoporosis and leads to a clinically significant reduction in scan rates.
Disclosure of interest None Declared.
Collier, JD, Ninkovic, M, Compston JE. Guidelines on the management of osteoporosis associated with chronic liver disease. Gut 2002;50(Suppl I):i1–i9
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