3:09 PM Abstract No. 248 Bone density changes after transjugular intrahepatic portosystemic shunt creation in patients with cirrhosis

Abstract

To explore changes in bone density after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis. Among patients with cirrhosis undergoing TIPS creation between June 2003–January 2019 (n = 503) those with available non-contrast abdominal computed tomography during 1 month before and 6 months after TIPS were selected (n = 29). After exclusion of 2 cases due to TIPS thrombosis during 6 months, data regarding 27 subjects were analyzed. Axial L1 –L4 vertebral body CT density value was measured at 5 levels (mid-body, adjacent to the epiphyseal plates and midlines between mid-body and epiphyseal plate) using free-hand region of interest selection technique. CT density values (Hounsfield Unit) were averaged for each vertebra and per patient. Baseline and post-TIPS values were compared using the repeated measures analysis of variance (rANOVA). Cox regression analysis was used to evaluate association of post-TIPS bone density changes with overall survival. The primary indications for TIPS included refractory ascites (81.5%) or variceal bleeding (18.5%). Median bone density at baseline was 128.1 HU (range, 70.3 – 316.7) with a median post-TIPS change of 3.3 (range, -19.8 – 35.5) [median 102.2% (range, 79.7 – 124.9%) compared to baseline]. There was no statistically significant trend for bone Hounsfield Unit values after TIPS compared to baseline neither in overall analysis (P = 0.216) nor after splitting by TIPS indication (P = 0.263 and 0.656 for fluid overload and variceal bleeding, respectively). Also, there was no statistically significant association between pre-TIPS bone density (1.00, P = 0.993), post-TIPS absolute changes in HU values (HR: 0.98, P = 0.402) or relative changes to the baseline HU (HR: 0.98, P = 0.471) and post-TIPS overall survival. Osteoporosis is common in cirrhosis. TIPS creation can reverse cirrhosis-related muscle wasting. However, bone density does not change during 6 months after TIPS creation. Therefore the patients can still be in risk of fractures despite gaining muscle strength. More observations with longer follow-ups would further reveal any potential association.