Fracture risk calculation tool enhances dual-energy X-ray absorptiometry scan referral pathway in cirrhosis patients. Issue 7 (July 2016)

• Record Type: Journal Article
• Authors: Nicoll, Ruairidh; Black, Alison; Bailey, Lorna; Dundas, Pauline; McLeman, Lindsay; Vijayan, Balasubramaniam; Fraser, Andrew; Mukhopadhya, Ashis
• Is Part Of: European journal of gastroenterology & hepatology. Volume 28:Issue 7(2016:Jul.)
• Publication Date: 2016-07
• Subjects: cirrhosis -- fracture risk -- FRAX -- osteoporosis -- sensitivity and specificity; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000585
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objectives: Liver cirrhosis is associated with osteoporosis leading to an increased risk of fractures. We aimed to establish whether a risk stratification strategy using a fracture risk calculation tool (FRAX) to determine which patients should receive a dual-energy X-ray absorptiometry (DXA) scan is effective in reducing scan rates without compromising sensitivity for detecting osteoporosis. Methods: A retrospective analysis of 252 patients with liver cirrhosis attending hepatoma surveillance clinics. Receiver operating characteristic analysis was performed to assess sensitivity and specificity at 10-year fracture risk thresholds of 5, 10 and 15%. Results: DXA scans were performed among 252 patients. Mean age was 61.6±10.2 years, of which 53.2% were male. Cirrhosis aetiology was largely a result of alcohol excess ( n =33.3%), chronic hepatitis C virus infection ( n =20.2%) and nonalcoholic fatty liver disease ( n =15.9%). The majority of patients were in good prognostic groups (87.4% Child–Pugh A, 11.3% Child–Pugh B, 1.3% Child–Pugh C). Osteoporosis was present in 19.0% of those who underwent DXA scanning. The optimum 10-year fracture risk threshold was found to be 10% using the FRAX tool. This retained a high sensitivity of 95.8%, specificity 64.7%, and negative predictive value 98.5%. Introduction of a 10% FRAX threshold would result in a reduction of the DXA scanning rate to 46.8% of the current rate. Conclusion: A risk stratification strategy for DXA scanning using a fracture risk assessment tool (FRAX) and a 10-year fracture risk threshold of 10% leads to a significant reduction in scan rates without compromising osteoporosis detection rates.