УДК 616.36-004:616-007.251:616.71-007.234]-07
Introduction. The problem of osteoporotic fractures and the evaluation thresholds forintervention in patients with liver cirrhosis (LC) remains obscure so far.Ukrainian model offracture risk assessment (FRAX®) has never been implemented among patients with LC in Ukraine.
The aim of the study. To find out the peculiarities of the Ukrainian model of Fracture Risk Assessment, its diagnostic and prognostic value for implementation among patients with liver cirrhosis accompanied by impaired bone mineral density.
Materials and methods.90 patients with LC(27 women and 63 men aged 18 to 66 years) were randomly assignedinto the study. Stratification into groups was based on information about bone condition. 72 patients were included intoan experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Controlgroup (CG) included18 patients without IBMD.
The peculiaritiesof the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorderswereestablished (significant differences betweenfrequency of features in groups and substantial stochastic associations of featureswithIBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value,predictive value, likelihood ratio) of the detected features for IBMDin general,osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LCin the case ofapplying the identified features.
The results.It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EGand CG, including EGB and CG,and EGA and EGB; between the frequency of cases of normal body weight, as well as overweight in EGand CG, including EGB and CG. The evaluation thresholdsaccording to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EGB and CGand in EGA and EGB; theintermediatevalues of fracture risk – in EGA and CG; the values below the lower evaluation threshold – in EGand CG, as well as in EGA and CGand in EGB and CG, including. Bone disorders had a substantialdirect stochastic associationin the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight andvalues abovethe upper evaluation threshold.All manifestations of bone disorders had substantial negativestochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis withshort height (indicates that features are inherent for normal bone mineral density).
It was foundoutthat fracture risk factors and evaluation thresholdsaccording to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease beingdetected, or deny it in thecasethey are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders beingpresent in patient with LC.The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, andexcluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® modelare highly specific forosteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® modelare medium-specificfor osteopenia, but can be more useful forexcluding osteopenia if they are absent. The overweight,especially the values below the lowerevaluation threshold, will most likely indicatenormal bone mineral density.
Conclusions.The use of the Ukrainian modelofFracture Risk Assessment (FRAX®) has certain peculiarities and can be valuable tool for detecting or excluding impaired bone mineral density in patients with liver cirrhosis.