Screening and Treatment for Osteoporosis Lacking for Persons with Cirrhosis, According to Real-World Analysis

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A minority of patients with cirrhosis are screened for osteoporosis and less than a quarter of persons who are diagnosed with osteoporosis are started on treatment, according to a recent real-world retrospective analysis.

Among the 22.6% of patients with cirrhosis who did receive treatment for osteoporosis, adverse events to medication were uncommon, reported researchers in Alimentary Pharmacology & Therapeutics, underscoring the importance of ensuring that those who are candidates for treatment are able to receive it.

“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,” wrote first author Mary Thomson, MD, MSc, assistant professor of medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, and colleagues. “Thus, prevention of osteoporosis and osteoporosis-related fractures can improve clinical outcomes in patients with cirrhosis.” The authors add, however, that bone disease is often overlooked in these patients.

Investigators conducted the current study to evaluate osteoporosis screening, medical management, and adverse events related to therapy in patients with cirrhosis. They performed a retrospective chart review of 5398 adults (median age, 59 years; 55.6% men) seen in primary care and gastroenterology/hepatology clinics over a 6-year period (2015-2021).

Researchers collected data on patient demographics, liver and bone health comorbidities, dual X-ray absorptiometry (DEXA) scan results, and medications. The primary outcome was screening for osteoporosis, which was defined as having a DEXA scan ordered within 3 years prior to or after a cirrhosis diagnosis, according to the study.

FINDINGS

Thomson and colleagues reported that participants 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%) virus infection, and cholestatic liver disease (7.4%). Also, most patients had decompensated cirrhosis (64.6%) and the average MELD-sodium (MELD-Na) score was 12.8.

Between 2015 and 2021, 23.5% of patients had a DEXA scan ordered and only 12.5% completed this test, according to the results.

Multivariable analysis showed patients with ordered scans were more likely to be older (odds ratio [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), and to have 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).

In addition, patients with DEXA 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%).

“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,” concluded investigators.

Source: Thomson M, Scott A, Trost S, Lake J, Lim N. Low screening rates and high prevalence of osteoporosis in cirrhosis: A real-world retrospective analysis. Aliment Pharmacol Ther. Published online December 7, 2023. doi:10.1111/apt.17823