De Arka, Ray Debadrita, Lamoria Sandeep, Sharma Vishal, Khurana Tilak Raj
Department of Hepatology Post Graduate Institute of Medical Education and Research Chandigarh India.
Department of Laboratory Oncology All India Institute of Medical Sciences New Delhi India.
JGH Open. 2020 Jun 12;4(5):945-949. doi: 10.1002/jgh3.12369. eCollection 2020 Oct.
The main clinical relevance of hepatic osteodystrophy is the increased risk of fractures. Dual-energy X ray absorptiometry (DEXA)-based assessment of bone mineral density, the current gold standard for diagnosing osteoporosis, is not the sole determinant of fracture risk. Other clinical risk factors also play an important role. This study was carried out to assess the prevalence and risk factors of hepatic osteodystrophy and estimate the entailed fracture risk by using the FRAX tool in a cohort of Indian cirrhotics.
Consecutive patients with cirrhosis ( = 120) were recruited. Etiologic workup, liver function tests, serum calcium, phosphate, 25(OH)D, HbA1c, and DEXA scan were performed. Hepatic osteodystrophy was defined as a T score of < -1. FRAX scores were calculated using the Indian calculator.
The study cohort was predominantly male (86.7%) with a median age of 49 (40-65) years. Alcohol was the most common etiology (80%). All patients had Child-Turcotte-Pugh class B (63.3%) or class B (36.7%) cirrhosis. Hepatic osteodystrophy was present in 83.3% patients. On multivariate analysis, smoking (odds ratio [OR]: 3.1 [1.76-4.7], < 0.001) and serum 25(OH)D (OR: 0.23 [0.09-0.94]; = 0.03) showed significant association with hepatic osteodystrophy. The 10-year probability of major osteoporotic fracture and hip fracture was 5.7% (2.1-28.9) and 2.5% (1.4-7.4), respectively. Using a FRAX probability cut-off of 20% for major osteoporotic fracture and 3% for hip fracture, 30% patients qualified for osteoporosis treatment.
Hepatic osteodystrophy is widely prevalent among Indian patients with cirrhosis and entails a high risk of fractures. Approximately one-third of patients with cirrhosis need treatment to reduce the risk of osteoporotic fractures.
肝性骨营养不良的主要临床关联是骨折风险增加。基于双能X线吸收法（DEXA）评估骨密度，这是目前诊断骨质疏松症的金标准，但并非骨折风险的唯一决定因素。其他临床风险因素也起着重要作用。本研究旨在评估印度肝硬化患者队列中肝性骨营养不良的患病率和风险因素，并使用FRAX工具估计相关骨折风险。
连续招募120例肝硬化患者。进行病因检查、肝功能测试、血清钙、磷、25（OH）D、糖化血红蛋白（HbA1c）和DEXA扫描。肝性骨营养不良定义为T值＜-1。使用印度计算器计算FRAX评分。
研究队列以男性为主（86.7%），中位年龄为49（40 - 65）岁。酒精是最常见的病因（80%）。所有患者均为Child-Turcotte-Pugh B级（63.3%）或C级（36.7%）肝硬化。83.3%的患者存在肝性骨营养不良。多因素分析显示，吸烟（比值比[OR]：3.1[1.76 - 4.7]，P＜0.001）和血清25（OH）D（OR：0.23[0.09 - 0.94]；P = 0.03）与肝性骨营养不良显著相关。主要骨质疏松性骨折和髋部骨折的10年概率分别为5.7%（2.1 - 28.9）和2.5%（1.4 - 7.4）。使用主要骨质疏松性骨折FRAX概率临界值20%和髋部骨折3%，30%的患者符合骨质疏松症治疗标准。
肝性骨营养不良在印度肝硬化患者中广泛存在，且骨折风险高。约三分之一的肝硬化患者需要治疗以降低骨质疏松性骨折风险。
