O13 Prevalence of osteoporosis and use of FRAX in patients with intestinal failure. (19th June 2022) - Harris, Richard
Abstract : Introduction: Patients on home parenteral nutrition (HPN) are recognised to be at high risk of metabolic bone disease (MBD). ESPEN guidelines recommend screening with annual DEXA (Dual-energy X-ray absorptiometry) scans for all patients on HPN. The National Institute for Health and Care Excellence states that DEXA scans should not routinely be performed without prior risk assessment e.g. by Fracture Risk Assessment Tool (FRAX). FRAX is used pre-DEXA to estimate the 10 year probability of major osteoporotic or hip fracture, stratifying patients into low, intermediate and high risk of fracture; DEXA scan should be considered in patients with intermediate or high risk scores. There are currently no data on FRAX use in patients on HPN. The aim of this study was to evaluate the prevalence of MBD in a cohort of patients on HPN and the utility of FRAX in identifying patients with MBD. Methods: The electronic records of all patients with intestinal failure on home intravenous support during August 2021 at a single tertiary UK centre were analysed. Demographics, type and duration of intravenous support, date and result of last DEXA scan and osteoporosis risk factors were collected. FRAX scores were calculated for all patients and compared with DEXA results where these were available. Results: 118 patients were on home parenteral support at the time of the study, with 79 (67.1% female) on parenteral nutrition (PN) and 39 (79.5% female) on parenteral fluids (PF). The average age was 53 and 63 years for patients on PN and PF respectively. Patients on PN had been on support for a mean of 4.6 years and for PF 5.4 years. 70 (59.3%) had a DEXA scan result available (44 on PN and 27 on PF). Of those, 16 (22.9%, 8 PN, 8 PF) had normal bone density, 24 (34.2%, 16 PN, 9 PF) osteopenia and 30 (42.9%, 20 PN, 10 PF) osteoporosis. Femoral T score correlated with BMI (r=0.45, p<0.01) but not age, sex, type of support or time on support. 23/70 were low risk by FRAX but with DEXA diagnosis of osteopenia in 13 (56.5%) and osteoporosis in 4 (17.4%). The remaining 47 were intermediate or high risk by FRAX, with DEXA diagnosis of osteopenia in 12 (25.5%) and osteoporosis in 25 (53.2%). Figure 1 shows FRAX risk versus femoral T score where available. Conclusions: Osteopenia and osteoporosis are common in patients on both PN and PF, with 77% of DEXA scans in our cohort being abnormal. A minority of patients were assessed as low risk of fracture by FRAX scores but this did not exclude MBD. We recommend that FRAX scores in the low risk range should not delay the performance of a baseline DEXA scan in this patient group.