Background Hepatic osteodystrophy is a frequent complication of chronic hepatopathies, although its knowledge in immune mediated chronic liver disease as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune cholangitis (AIC) is scarce.
Objectives 1. To study the prevalence of fragility fractures, osteoporosis (OP) and osteopenia and its association with the severity of hepatopathy (Child-Pugh, MELD) and the hepatic fibrosis stage (FibroScan®) in this population. 2. To assess whether a T-score <-1.5 could be a cut-off point that identifies an increased risk of fracture in these patients. 3. To estimate their absolute risk of fracture using the FRAX® tool. 4. To analyze if clinical practice is in compliance with treatment recommendations of OP proposed by the European Association for the Study of the Liver (EASL) and FRAX guidelines.
Methods Preliminary cross-sectional observational study of bone density and fragility fractures in patients with PBC, PSC and AIC attended at our hospital during last year. Among 107 eligible patients, 45 (53%) fulfilled the inclusion criteria of having bone mineral density (BMD) evaluation by dual X-ray absorptiometry (DXA) using an Hologic QDR 4500-Elite® densitometer at lumbar spine and total hip. The protocol included a questionnaire for sociodemographic variables, fractures and OP risk factors.
Results Mean age was 57 yrs (range: 28-81 yrs) and 84% were women (31% postmenopausal). Disease distribution was: 89% PBC, 6.7% AIC and 4.4% PSC. BMD assessment is shown in Table.
Prevalence of global fractures was 38% (non vertebral 38% and vertebral 7%). We found an association between vertebral fractures and serum bilirubin >1.3 mg/dL, serum albumin <3.4 g/dL and F4 stage by FibroScan® (p<0.05), which remained significant after adjustment for possible confusion factors. Likewise, hip fracture was associated with early menopause, F3 stage and lumbar spine and femoral neck OP (p<0.05). A T-score <-1.5 in lumbar spine (58.5% [95% CI: 42-75]) and femoral neck (53% [95% CI: 48-69]) did not correlate with prevalent fractures. The mean 10 yrs absolute risk of fractures obtained by FRAX® was 6% for major fractures and 2% for hip fracture. Doctors younger than 40 yrs had ordered DXA more frequently (68%) than doctors over 40 yrs (46), p=0.05. OP prevention and treatment was in compliance with EASL guidelines in 58% of eligible patients. FRAX® recommendations identified 22% patients eligible for OP treatment whereas EASL guidelines identified 58% (p=0.001).
Conclusions Prevalence of OP in cholangiopathies was greater than described for general Spanish population of the same age. A T-score <-1.5 was not associated with increased fracture risk in our patients. FRAX® identified less eligible patients for OP treatment than EASL guidelines. There is still a high prevalence of undertreatment of bone loss in patients with cholangiopathies.
Disclosure of Interest None Declared