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Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis
BACKGROUND AND AIM: The main clinical relevance of hepatic osteodystrophy is the increased risk of fractures. Dual‐energy X ray absorptiometry (DEXA)‐based assessment of bone mineral density, the current gold standard for diagnosing osteoporosis, is not the sole determinant of fracture risk. Other c...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wiley Publishing Asia Pty Ltd
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578334/ https://www.ncbi.nlm.nih.gov/pubmed/33102768 http://dx.doi.org/10.1002/jgh3.12369 |
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author | De, Arka Ray, Debadrita Lamoria, Sandeep Sharma, Vishal Khurana, Tilak Raj |
author_facet | De, Arka Ray, Debadrita Lamoria, Sandeep Sharma, Vishal Khurana, Tilak Raj |
author_sort | De, Arka |
collection | PubMed |
description | BACKGROUND AND AIM: The main clinical relevance of hepatic osteodystrophy is the increased risk of fractures. Dual‐energy X ray absorptiometry (DEXA)‐based assessment of bone mineral density, the current gold standard for diagnosing osteoporosis, is not the sole determinant of fracture risk. Other clinical risk factors also play an important role. This study was carried out to assess the prevalence and risk factors of hepatic osteodystrophy and estimate the entailed fracture risk by using the FRAX tool in a cohort of Indian cirrhotics. METHODS: Consecutive patients with cirrhosis (n = 120) were recruited. Etiologic workup, liver function tests, serum calcium, phosphate, 25(OH)D, HbA1c, and DEXA scan were performed. Hepatic osteodystrophy was defined as a T score of < −1. FRAX scores were calculated using the Indian calculator. RESULTS: The study cohort was predominantly male (86.7%) with a median age of 49 (40–65) years. Alcohol was the most common etiology (80%). All patients had Child‐Turcotte‐Pugh class B (63.3%) or class B (36.7%) cirrhosis. Hepatic osteodystrophy was present in 83.3% patients. On multivariate analysis, smoking (odds ratio [OR]: 3.1 [1.76–4.7], P < 0.001) and serum 25(OH)D (OR: 0.23 [0.09–0.94]; P = 0.03) showed significant association with hepatic osteodystrophy. The 10‐year probability of major osteoporotic fracture and hip fracture was 5.7% (2.1–28.9) and 2.5% (1.4–7.4), respectively. Using a FRAX probability cut‐off of 20% for major osteoporotic fracture and 3% for hip fracture, 30% patients qualified for osteoporosis treatment. CONCLUSION: Hepatic osteodystrophy is widely prevalent among Indian patients with cirrhosis and entails a high risk of fractures. Approximately one‐third of patients with cirrhosis need treatment to reduce the risk of osteoporotic fractures. |
format | Online Article Text |
id | pubmed-7578334 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wiley Publishing Asia Pty Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-75783342020-10-23 Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis De, Arka Ray, Debadrita Lamoria, Sandeep Sharma, Vishal Khurana, Tilak Raj JGH Open Original Articles BACKGROUND AND AIM: The main clinical relevance of hepatic osteodystrophy is the increased risk of fractures. Dual‐energy X ray absorptiometry (DEXA)‐based assessment of bone mineral density, the current gold standard for diagnosing osteoporosis, is not the sole determinant of fracture risk. Other clinical risk factors also play an important role. This study was carried out to assess the prevalence and risk factors of hepatic osteodystrophy and estimate the entailed fracture risk by using the FRAX tool in a cohort of Indian cirrhotics. METHODS: Consecutive patients with cirrhosis (n = 120) were recruited. Etiologic workup, liver function tests, serum calcium, phosphate, 25(OH)D, HbA1c, and DEXA scan were performed. Hepatic osteodystrophy was defined as a T score of < −1. FRAX scores were calculated using the Indian calculator. RESULTS: The study cohort was predominantly male (86.7%) with a median age of 49 (40–65) years. Alcohol was the most common etiology (80%). All patients had Child‐Turcotte‐Pugh class B (63.3%) or class B (36.7%) cirrhosis. Hepatic osteodystrophy was present in 83.3% patients. On multivariate analysis, smoking (odds ratio [OR]: 3.1 [1.76–4.7], P < 0.001) and serum 25(OH)D (OR: 0.23 [0.09–0.94]; P = 0.03) showed significant association with hepatic osteodystrophy. The 10‐year probability of major osteoporotic fracture and hip fracture was 5.7% (2.1–28.9) and 2.5% (1.4–7.4), respectively. Using a FRAX probability cut‐off of 20% for major osteoporotic fracture and 3% for hip fracture, 30% patients qualified for osteoporosis treatment. CONCLUSION: Hepatic osteodystrophy is widely prevalent among Indian patients with cirrhosis and entails a high risk of fractures. Approximately one‐third of patients with cirrhosis need treatment to reduce the risk of osteoporotic fractures. Wiley Publishing Asia Pty Ltd 2020-06-12 /pmc/articles/PMC7578334/ /pubmed/33102768 http://dx.doi.org/10.1002/jgh3.12369 Text en © 2020 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles De, Arka Ray, Debadrita Lamoria, Sandeep Sharma, Vishal Khurana, Tilak Raj Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title | Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title_full | Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title_fullStr | Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title_full_unstemmed | Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title_short | Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis |
title_sort | hepatic osteodystrophy and fracture risk prediction using frax tool in indian patients with cirrhosis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578334/ https://www.ncbi.nlm.nih.gov/pubmed/33102768 http://dx.doi.org/10.1002/jgh3.12369 |
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