Osteoporosis and FRAX risk in patients with liver cirrhosis

• Main Authors: Azucena I. Casanova-Lara, Pilar A. Peniche-Moguel, José L. Pérez-Hernández, Eduardo Pérez-Torres, Galileo Escobedo González, Chantal J. Córdova-Gallardo
• Format: Article
• Language: English
• Published: Permanyer 2014-10-01
• Series: Revista Médica del Hospital General de México
• Subjects: Hepatic osteodystrophy; Bone mineral density; Densitometry; FRAX; Osteoporosis; Osteopenia
• Online Access: http://www.sciencedirect.com/science/article/pii/S0185106314000316

Background: Hepatic osteodystrophy is any bone disease in patients with chronic liver disease. To measure bone mineral density (BMD) T-score by bone densitometry (BD) is used, classifying the disease in osteopenia, osteoporosis and severe osteoporosis. There are not criteria for monitoring and detection of osteodystrophy in cases of non-cholestasic cirrhosis. To determine the risk of fracture at 10 years, Fracture Risk Assessment Tool (FRAX), could be useful. Objectives: Determine the frequency of hepatic osteodystrophy in cirrhotic patients according to BD and FRAX and identify associated risk factors. Patients and methods: An observational, analytic, cross-sectional study. We included cirrhotic patients with report of DO and FRAX. Results: 52 patients were included, 38 were female (73.1%). The mean age was 12.29 ± 55.46 year-old, MELD 4.14 ± 11.71. In cholestatic etiology Mayo Score was 2.9 ± 3.31. The BMD was 0.756 ± 0.1896 mg/ cm 2 and T-score -2.34 ± 1.0. Of all patients, 26 (50%) had ranges of osteopenia and 21 (40.4%) of osteoporosis. Fracture risk with FRAX 10-year was 7.77 ± 6,713, and when we added the value of T-score fracture risk was 13.72 ± 12. Higher prevalence of cholestatic diseases in women and viral etiology in men (P = 0.006) was observed. There was significant relationship between cholestatic etiology T-score, alkaline phosphatase, and elderly and FRAXS with T-score (P =< 0.05). Vitamin D was lower in patients with cholestatic liver disease (P = 0.047) and a trend towards lower value of FRAX in patients with cholestatic liver disease was observed. Conclusions: The frequency of osteoporosis or osteopenia is 90.4% in Mexican patients with liver cirrhosis of different etiologies. The decreased levels of bone alkaline phosphatase and 25-hydroxyvitamin-D were correlated with the risk of bone disease in patients with liver cirrhosis.