Assessing the Prevalence of Risk Factors for Osteoporosis and Rate of Screening by Dexa Scan in Patients Referred for Liver Transplant Evaluation

A. France¹, J. Kirk², M. Dokus², B. Al-Judaibi², M. Laryea²

¹Department of Internal Medicine, University of Rochester Medical Center, Rochester, NY, ²Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY

Meeting: 2021 American Transplant Congress

Abstract number: 481

Keywords: Liver cirrhosis, Liver transplantation, Osteoporosis

Topic: Administrative » Quality Assurance Process Improvement & Regulatory Issues

Session Information

Session Name: Quality Assurance Process Improvement & Regulatory Issues

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Osteoporosis (OP) and fragility fractures are well-known complications of both chronic liver disease (CLD) and transplant, with a significant increase in the prevalence of fractures in months after liver transplant (LT). The objectives of this quality improvement project were to assess whether patients with CLD are appropriately screened for OP, to determine the prevalence of additional risk factors for bone loss in pre-LT patients and to ascertain whether systematic screening for low bone mineral density (BMD) should be a routine component of LT evaluation.

*Methods: A retrospective chart review was performed of patients referred for LT evaluation at a large academic medical center from July 20 – November 5, 2020. Baseline characteristics including etiology of CLD, risk factors for OP, history of fractures and prior screening for low BMD with DEXA scans were reviewed. Assessment of nutritional and lifestyle risk factors was conducted by the transplant dietician.

*Results: The median age for our population was 59 years; 48% of the population was female, and the most common reason for liver transplant evaluation referral was alcoholic cirrhosis. Of 84 patients referred for LT evaluation, 17 (20.2%) had a DEXA scan to screen for low BMD. Among the 17 patients with DEXA scans, 5 had osteopenia and 2 had OP. Three of those 7 were prescribed Vitamin D. Seventy-six patients (90%) had at least one risk factor for OP other than CLD. In the 47 patients that had 2 or more risk factors, 13 (28%) had a DEXA scan. The median MELD-Na score was 17. Of the 24 patients with MELD <15, 8 had a DEXA scan compared with 8/48 patients with MELD 15-25 and 1/12 patients with a MELD >25.

*Conclusions: The low rate of screening for OP in this high risk population highlights a gap in the care of patients with advanced CLD. Even patients with multiple other risk factors for OP have a low rate of screening. Given the known impact of LT on bone density and the morbidity associated with fragility fractures, there is need for increased education about the risks of low BMD in patients with CLD at the primary care level, and BMD assessment should be a routine part of the transplant evaluation.

Table 1. Prevalence of OP Risk Factors
*Most prevalent risk factors for low BMD*	*Number of patients (%)*
Age >50	57 (68%)
Current tobacco use	24 (29%)
BMI <21	12 (14%)
Excessive alcohol consumption	10 (12%)
Glucocorticoid use	7 (8%)
Prior fragility fracture	4 (5%)

To cite this abstract in AMA style:

France A, Kirk J, Dokus M, Al-Judaibi B, Laryea M. Assessing the Prevalence of Risk Factors for Osteoporosis and Rate of Screening by Dexa Scan in Patients Referred for Liver Transplant Evaluation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/assessing-the-prevalence-of-risk-factors-for-osteoporosis-and-rate-of-screening-by-dexa-scan-in-patients-referred-for-liver-transplant-evaluation/. Accessed November 27, 2024.

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