Assessment of Osteoporosis with Aspartate Aminotransferase to Platelet Ratio Index Score in Patients of Chronic Liver Disease

Abstract

Objective: to assess Osteoporosis with APRI score (aspartate aminotransferase to platelet ratio index) in patients with chronic liver disease.

Study Design: Cross-sectional study.

Study Setting and Duration: Pak Emirates Military Hospital Rawalpindi, Pakistan from Jan to Dec 2021.

Methodology: All Adult patients aged 18 years and above with clinical and imaging features suggestive of chronic liver disease were included in the study. APRI score calculated as the ratio of aspartate aminotransferase to platelet based on the laboratory analysis of Aspartate aminotransferase (AST) and platelet levels was done. Furthermore, a bone density scan (DEXA scan) was also carried out for all the study participants.

Results: One hundred and sixty patients fulfilling the inclusion criteria were included. Of the total 160 cases, 53(33.1%) had normal bone density on DEXA scans, 43(26.9%) had Osteopenia and 64(40%) had Osteoporosis. Twenty-nine cases of chronic liver disease cases (25%) had APRI scores <0.3, 40(25%) had APRI scores>0.3 and<0.5, 37 cases (23.1%) had APRI scores>0.5 and <1.5, 30 cases (18.8%) had APRI score >1.5 and <2 and 24 patients (15%) had APRI score >2. The significant (p<0.001) association was observed between APRI score and bone density, showing bone density decreased with the progression of the disease.

Conclusion: Patients with chronic liver disease almost invariably develop Osteoporosis with the progression of the disease. Early recognition and treatment are pivotal to lessen morbidity and mortality associated with Osteoporosis.

Keywords: Aspartate aminotransferase, Chronic liver disease, Hepatitis C, Osteoporosis, Osteopenia, Platelet.