Enhancing Fracture Risk Assessment and Referral
No Thumbnail Available
Authors
Jones A.
Satheesha S.
Ballesteros K.
Sharma, V.
Check for full-text access
Issue Date
2025
Type
Article
Language
Keywords
Alternative Title
Abstract
Osteoporosis is a recognised complication of chronic liver disease, with cirrhotic patients at increased fracture risk. EASL guidelines recommend bone densitometry for all cirrhotics. Despite this, bone mineral density (BMD) assessments remain inconsistent in decompensated cirrhosis. This study evaluates the impact of a nurse and pharmacist-led pathway on osteoporosis surveillance in this high-risk cohort A retrospective service evaluation was conducted to assess osteoporosis and associated risk factors in patients attending a decompensated cirrhosis clinic. Data collected included vitamin D levels, FRAX scores, BMD via DXA scans, and treatment recommendations per National Osteoporosis Guideline Group (NOGG). Falls, fractures, and related outcomes were also documented. 112 patients were included in this analysis, 73 were male (65.1%) The mean patient age was 57 (+/- 11.2). Average UKELD score was 51.8 (+/- 4.2). Of the 112 patients, 82 (73.2%) had a history of alcohol-related liver disease, 4 (3.5%) immune mediated liver disease, 6 (5.4%) viral hepatitis, 19 (17%) metabolic dysfunction associated liver disease and 2 (1.8%) cryptogenic cirrhosis. 44 (39.3%) patients had a DXA scan result available. 20 (17.9%) patients have a DXA scan pending. Only 1 (0.9%) patient had a DXA scan result available prior to development of this pathway. 17 (15.1%) patients are deceased or on an end-of-life pathway. 15 (13.4%) patients missed their appointment. 13 (11.6%) patients did not have a DXA scan ordered. 2 (1.8%) patients were already on bisphosphonate therapy, 1 (0.9%) patient had transferred care. Of the 44 patients who had a DXA, 5 (11.4%) patients had osteoporosis, 19 (43.2%) had osteopenia. 5 (11.4%) patients were referred to for bisphosphonate therapy. 44 (49.3%) patients had their vitamin D checked, with 20 (17.9%) patients having an adequate level (>50 nmol/L) not requiring treatment. 49 (43.8%) patients had a history of falls, of which 23 resulted in fractures (20.1%). 3 patients had fractures without falls (2.7%). 43 (38.4%) patients attended A&E following their fall or fracture, with 26 (23.2%) patients admitted as inpatients. Additional risk factors included smoking (41.1%), alcohol excess (75%), low BMI (10.7%), prolonged steroid use (8%), and PPI use (45.5%). This study demonstrates that a nurse and pharmacist-led pathway improved osteoporosis screening in patients with decompensated cirrhosis, increasing the identification of patients requiring intervention. Wider implementation of such pathways could reduce fracture-related morbidity in this population.
Description
Citation
Publisher
License
Journal
Gut