Case Western Reserve University School of Medicine Cleveland, OH, United States
Leslie Ha, BS1, Gold A. Adkins, MD2, Lenche Kostadinova, MD3, Perica Davitkov, MD4, Yngve Falck-Ytter, MD5, Donald Anthony, MD6, Sagarika Satyavada, MD2, Maya Mattar, MD6 1Case Western Reserve University School of Medicine, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 3Case Western Reserve University, Cleveland, OH; 4VA Medical Center Cleveland, Cleveland, OH; 5VA North East Ohio Health Care System, Cleveland, OH; 6Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Introduction: Osteoporosis is a well-known complication of chronic liver disease (CLD), with an estimated prevalence of up to 55% in cirrhotic patients. While fractures occur in nearly half of patients with CLD, bone disease remains under-diagnosed in this population, as a third of vertebral fractures are asymptomatic. Despite current guidelines supporting the utility of BMD monitoring, little data exists on whether these guidelines are currently reflected in the standard of care for CLD. In this study, we measured the frequency of DEXA exams in cirrhotic patients at a VA center before and after a provider-targeted educational intervention.
Methods: This was a quality improvement project conducted at Cleveland VA Medical Center. ICD 10 codes for a diagnosis of liver cirrhosis were used to identify the patient population. Chart review for verification of cirrhosis, DEXA scans and indications was performed in September 2020. Subsequently, an intervention of 5 teaching sessions was provided to internal medicine residents in primary care clinic in February 2021. Chart review was completed again April 2021, following this intervention to assess for changes in the frequency of DEXA scan orders for osteoporosis screening in patients with cirrhosis.
Results: Of 350 patients with cirrhosis seen in September 2020, etiologies of cirrhosis included alcoholic liver disease (29%), cholestatic liver disease (9.6%), viral hepatitis (45.1%), and non-alcoholic fatty liver disease (12.9%). Thirty-one patients (8.8%) had received a DEXA scan pre-intervention. Six (19.3%) of the 31 patients had osteoporosis, 16 (51.6%) had osteopenia and 8 (25.8%) had normal bone density. The most common indication for DEXA scan order was for osteoporosis screening due to CLD (64.5%). Following the intervention, 16 of 232 patients (6.8%) patients underwent DEXA scan in April 2021. The primary indication for DEXA scan orders was osteoporosis screening due to CLD (83%). Of these 16 patients, 4 (25%) had osteoporosis, 6 (37.5%) had osteopenia and 6 (37.5%) had normal bone density scan.
Discussion: Despite a high prevalence of osteoporosis in cirrhosis patients and published guidelines highlighting the importance of regular DEXA scans, BMD testing is not universally ordered. Future studies should explore barriers to pursuing bone health evaluations and educational interventions that may increase osteoporosis screening in chronic liver disease patients.
Disclosures: Leslie Ha indicated no relevant financial relationships. Gold Adkins indicated no relevant financial relationships. Lenche Kostadinova indicated no relevant financial relationships. Perica Davitkov indicated no relevant financial relationships. Yngve Falck-Ytter indicated no relevant financial relationships. Donald Anthony indicated no relevant financial relationships. Sagarika Satyavada indicated no relevant financial relationships. Maya Mattar indicated no relevant financial relationships.
Leslie Ha, BS1, Gold A. Adkins, MD2, Lenche Kostadinova, MD3, Perica Davitkov, MD4, Yngve Falck-Ytter, MD5, Donald Anthony, MD6, Sagarika Satyavada, MD2, Maya Mattar, MD6. P1828 - Evaluation of an Educational Intervention to Improve Osteoporosis Screening Practices in Cirrhotic Patients: A Quality Improvement Project, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.