Less than 25% of patients with cirrhosis, low bone density are treated for osteoporosis
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Key takeaways:
- Over the 6-year study period, 23.5% of patients with cirrhosis had a DEXA scan ordered and 12.5% completed the test.
- Results showed 30.2% had osteoporosis but only 22.6% received treatment.
Patients with cirrhosis are less frequently screened for osteoporosis compared with the general population, and less than 25% with low bone density actually receive treatment, according to research in Alimentary Pharmacology & Therapeutics.
“The pathophysiology of metabolic bone disease in chronic liver disease is complex,” Mary Thomson, MD, MSc, assistant professor of medicine in the division of gastroenterology, hepatology and nutrition at the University of Minnesota, and colleagues wrote. “Patients with cirrhosis are at a higher risk for osteoporosis-related fracture compared to the general population, which can dramatically impact quality of life and mortality. Thus, prevention of osteoporosis and osteoporosis-related fractures can improve clinical outcomes in patients with cirrhosis.”
They continued: “However, bone disease is often overlooked in the care of patients with cirrhosis.”
To evaluate osteoporosis screening, medical management and adverse events related to therapy in patients with cirrhosis, Thomson and colleagues performed a retrospective chart review of 5,398 adults (median age, 59 years; 55.6% men) seen in the M Health Fairview health system from 2015 to 2021.
Patients were predominantly white (79.1%) and the most common etiologies of cirrhosis were nonalcoholic fatty liver disease (75.4%), alcohol-related liver disease (52.8%), chronic hepatitis C (15.5%) and cholestatic liver disease (7.4%). Most patients had decompensated cirrhosis (64.6%) and the average MELD-Na score was 12.8.
During the 6-year period, 23.5% of patients had a dual X-ray absorptiometry (DEXA) scan ordered but only 12.5% completed the test. Multivariable analysis showed patients with ordered scans were more likely to be older (OR = 1.02; 95% CI, 1.02-1.03), women (OR = 2.11; 95% CI, 1.83-2.43) and white (OR = 1.27; 95% CI, 1.04-1.56), with higher MELD-Na scores (OR = 1.03; 95% CI, 1.02-1.04) and a history of hepatocellular carcinoma (OR = 1.82; 95% CI, 1.46-2.25).
Researchers also reported that patients with scan orders had a higher incidence of other osteoporosis risk factors, including rheumatoid arthritis (OR = 1.58; 95% CI, 1.08-2.32), breast cancer (OR = 1.74; 95% CI, 1.1-2.73) and postmenopausal status (OR = 8.45; 95% CI, 6.64-10.75).
Results from the DEXA scans showed 48.5% of patients had osteopenia and 30.2% had osteoporosis. Of those with osteoporosis, 22.6% received treatment, most commonly with oral bisphosphonates (13.4%). Rates of variceal bleeding were similar between patients who were and were not prescribed oral bisphosphonates (4.8% vs. 8.4%).
“A minority of patients with cirrhosis are screened for osteoporosis despite higher rates of abnormal bone density compared to the general population,” Thomson and colleagues concluded. “Moreover, under a quarter of patients diagnosed with osteoporosis were started on treatment.”
They continued: “While clearer, more comprehensive guidelines are needed to promote optimal screening for and treatment of osteoporosis in patients with cirrhosis, facilitating endocrinology consultation is a feasible potential solution to address the treatment gap in this population.”
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