Clinical Usefulness of FRAX Score for Predicting Sarcopenia in Patients with Chronic Liver Disease.

Chisato Saeki,Masanori Nakano,Tsunekazu Oikawa,Masayuki Saruta,Mitsuru Saito,Akihito Tsubota,Tomoya Kanai,Yuichi Torisu

doi:10.3390/jcm10184080

Abstract

We investigated the usefulness of the Fracture Risk Assessment tool (FRAX) for predicting sarcopenia in chronic liver disease (CLD). In this cross-sectional study, we evaluated 321 patients with CLD. The FRAX with and without bone mineral density (BMD) was employed to calculate the 10-year risks of major osteoporotic and hip fractures. The FRAX score for high fracture risk was defined as a 10-year major osteoporotic fracture probability of ≥20% or a 10-year hip fracture probability of ≥3%. The diagnosis of sarcopenia was based on the Japan Society of Hepatology criteria. According to the FRAX, with and without BMD, 134 (41.7%) and 193 (60.1%) patients had a high fracture risk, respectively. The high fracture risk group had a significantly higher frequency of sarcopenia than the non-high fracture risk group. FRAX scores of major osteoporotic and hip fractures were negatively correlated with handgrip strength and muscle mass. Using the FRAX with BMD, the cutoff scores of major osteoporotic and hip fractures for predicting sarcopenia were 8.55% (sensitivity/specificity, 0.847/0.568) and 3.35% (0.729/0.746), respectively. Using the FRAX without BMD, they were 18.5% (0.635/0.725) and 7.65% (0.729/0.758), respectively. The FRAX is a simple and convenient screening tool for predicting sarcopenia in patients with CLD.

Highlights

The liver is a multifunctional organ involved in vitamin D metabolism, hormonal regulation, and cytokine production; its impaired function can dysregulate bone homeostasis [1]
The prevalence of sarcopenia was significantly higher in patients with liver cirrhosis (LC) than in those with non-LC (32.9% vs. 20.2%, p = 0.010; Figure S1A), whereas the prevalence of osteoporosis was not significantly different between the two groups (33.5% vs. 31.9%, p = 0.754; Figure S1B)
The 10-year probabilities of major osteoporotic and hip fractures in all subjects based on the FRAX algorithm with

Summary

Introduction

The liver is a multifunctional organ involved in vitamin D metabolism, hormonal regulation, and cytokine production; its impaired function can dysregulate bone homeostasis [1]. Osteoporosis is frequently noticed in patients with chronic liver disease (CLD), characterized by reduced bone mass and microarchitectural deterioration of bone, and resultant fragility fractures [1,2,3,4]. The two major components of the musculoskeletal system are the bone and skeletal muscle, and their interaction, as mediated by mechanical and biochemical communication, is being recognized [7,8,9,10]. Sarcopenia, characterized by decreased skeletal muscle mass and function, is closely associated with osteoporosis and fragility fractures in patients with CLD [11,12]. The concept of osteosarcopenia has been established in order to represent this concomitant occurrence of sarcopenia and osteoporosis [13,14]

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Results

Conclusion