Abstract
INTRODUCTION: Low bone mineral density (BMD) is common in chronic liver disease and predisposes to fracture. FRAX score is a widely used web-based algorithm used to estimate fracture risk with or without dual-emission x-ray absorptiometry (DEXA). FRAX score has not been studied in patients listed for liver transplant. Aim of this study was to determine if FRAX score with DEXA is effective in patients with osteopenia listed for liver transplant to guide treatment for fracture prophylaxis. METHODS: 104 consecutive patients who were actively listed for liver transplant at Baylor St. Luke's medical center were included. Clinical and demographic patient information was collected retrospectively. FRAX scores calculated with BMD data. RESULTS: 104 patients (29 ALD, 26 HCV, 22 NASH, 27 others) were studied (mean age 56 ± 10, 59% male, 41% female, mean BMI 28 ± 5, mean MELD 17+8). All patients had bone mineral density assessed (13 [12%] were osteoporotic and 42 [40%] were osteopenic at the spine and/or hip. 4 [3.8%] had a previous osteoporotic fracture. Mean FRAX score for a 10-year probability of a hip fracture was 1.7% and a 10-year probability of a major osteoporosis-related fracture was 6.2% based on the US-adapted WHO algorithm. Among 40% osteopenic and 13% osteoporotic patients, only 3% and 8% of patients had significantly high FRAX score respectively. CONCLUSION: BMD FRAX score underestimated fracture risk in actively listed liver transplant patients. We believe this could be related to small sample size of the study and strict selection criteria for liver transplant listing. Majority of our study population was non-smoker, non-drinker and with a higher BMI. Therefore, future studies with bigger sample size would be helpful to utilize FRAX score to guide treatment in osteopenic patients for fracture prophylaxis.
Published Version
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