S1138 Screening for Vitamin D Levels and Bone Mineral Density Disease in Cirrhosis: Are We Doing It Right?

Abstract

INTRODUCTION: Vitamin D hydroxylation occurs in the liver. Currently there are no recommendations from national society guidelines regarding screening for vitamin D deficiency or bone mineral disease (BMD) in patient with cirrhosis. While there have been studies acknowledging the association between vitamin D deficiency, osteoporosis and liver cirrhosis, few studies have discussed the role of routine screening for vitamin D deficiency and BMD in cirrhosis. We aim to examine prevalence of vitamin D deficiency and BMD in patients with cirrhosis. METHODS: A retrospective review of patients admitted at our quaternary care facility with cirrhosis from 2013 to 2020 was performed. The splicer dicer application in Epic (electronic health record) was utilized to screen for patients with cirrhosis and recorded vitamin D levels which were included in the study. Variables included demographic data, etiology of cirrhosis, MELD score, vitamin D levels, presence of DEXA scan and chronic kidney disease (CKD). RESULTS: 137 patients with cirrhosis had documented Vitamin D levels. The range of MELD score was 6-40. Vitamin D deficiency was defined as a Vitamin D level <30ng/mL. Sixty-seven percent (92/137) of patients had vitamin D deficiency. The median Vitamin D level was 21.3 with a range between 5 and 120. The mean patient age at the lowest vitamin D level was 60.6 years with 66.3% of male and 33.7% females. Spearman’s rank-order correlation analysis showed a statistically significant and negative correlation between the lowest vitamin D level and the Meld score (Spearman’s rho = -0.291, P = .003). Forty percent of patients with vitamin D deficiency (37/92) had a history of cirrhosis and CKD (P = .736). On chart review 40 patients had a DEXA scan. BMD is defined as one T score < -1. Table 1 describes the correlation between BMD and vitamin D deficiency. CONCLUSION: Cirrhosis is an under recognized entity for secondary cause of BMD. Screening for vitamin D deficiency is not routinely performed in patients with cirrhosis, which is a high risk population for BMD due to comorbid conditions like CKD and alcohol use disorder. Our data demonstrated that cirrhotic patients with vitamin D deficiency were not likely to have a DEXA scan. Further studies with a control group should be performed to examine mortality benefit of vitamin D replacement and BMD screening in patients with chronic liver disease.Table 1.: Correlation between vitamin D levels and percentage of patients who had DXA scanning. Of those patients with DXA screening, percentage of patients with bone mineral deficiency is reported