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Casanova Lara Azucena I, Peniche Moguel Pilar A, Pérez Hernández José Luis, Pérez Torres Eduardo, Escobedo González Galileo, Córdova Gallardo Chantal Jaqueline.
Osteoporosis and FRAX risk in patients with liver cirrhosis
Rev Med Hosp Gen Mex 2014; 77(4)  : 173-174


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.

Palabras clave: Hepatic osteodystrophy; bone mineral density; densitometry; FRAX; osteoporosis; osteopenia.
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