Daily Dose: Lack of Osteoporosis Screening, Treatment in Patients with Cirrhosis

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in Alimentary Pharmacology & Therapeutics that evaluated osteoporosis screening, management, and adverse osteoporosis medication events in patients with cirrhosis.

The study

Researchers performed a retrospective chart review of 5398 adults (median age, 59 years; 55.6% men) seen in primary care and gastroenterology/hepatology clinics over a 6-year period (2015-2021). They collected data on patient demographics, liver and bone health comorbidities, dual X-ray absorptiometry (DEXA) scan results, and medications.

The primary outcome was screening for osteoporosis, which was defined as having a DEXA scan ordered within 3 years prior to or after a cirrhosis diagnosis.

The findings

Between 2015 and 2021, 23.5% of patients had a DEXA scan ordered and only 12.5% completed this test.

Multivariable analysis showed patients with ordered scans were more likely to be older (odds ratio [OR] 1.02, 95% CI 1.02-1.03), women (OR 2.11, 95% CI 1.83-2.43), and White (OR 1.27, 95% CI 1.04-1.56), and to have higher MELD-Na scores (OR 1.03, 95% CI 1.02-1.04) and a history of hepatocellular carcinoma (OR 1.82, 95% CI 1.46-2.25).

In addition, patients with DEXA scan orders had a higher incidence of other osteoporosis risk factors, including rheumatoid arthritis (OR 1.58, 95% CI 1.08-2.32), breast cancer (OR 1.74, 95% CI 1.1-2.73), and postmenopausal status (OR 8.45, 95% CI 6.64-10.75).

Authors' comment

“While clearer, more comprehensive guidelines are needed to promote optimal screening for and treatment of osteoporosis in patients with cirrhosis, facilitating endocrinology consultation is a feasible potential solution to address the treatment gap in this population."

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