{
  "abstract": "Background Patients with cirrhosis are at high risk of developing bone disease, including osteoporosis and fragility fractures, which significantly contribute to morbidity. Cirrhosis-related bone disease is multifactorial, involving altered vitamin D metabolism, impaired calcium absorption, and reduced bone formation. The British Society of Gastroenterology (BSG) best practice guidance on outpatient management of compensated cirrhosis recommends routine bone health assessment, fracture risk evaluation, and initiation of treatment in this population. However, adherence to these recommendations in routine clinical practice remains suboptimal. This audit evaluated bone disease management in cirrhosis inpatients routinely followed as outpatients, identifying care gaps and opportunities for improvement.Methods A retrospective review was conducted of 36 adult inpatients with clinically or radiologically confirmed cirrhosis over six months. Electronic medical records were examined for documentation of bone health screening (clinical assessment and DEXA scanning), referrals to bone or metabolic specialist clinics, records of falls or fractures, prescriptions of vitamin D and calcium supplementation, and initiation of osteoporosis-specific treatments. Data were compared against BSG guideline recommendations to evaluate adherence and identify deficits in care.Results Among 36 patients, 31% (n=11) had documented bone health screening; specialist referrals were rare (3%, n=1). Fragility fractures post-cirrhosis was recorded in 17% (n=6), and 31% (n=11) reported recent falls. Despite this, only 33% (n=2) of fracture patients received vitamin D therapy; none received bisphosphonates. Patients with recent falls were significantly more likely to have undergone bone health screening compared to those without falls (64% vs 24%, p=0.023), as were patients with fractures compared to those without (91% vs 10%, p=0.013). Overall, adherence to guideline-recommended assessment and treatment was poor, particularly regarding post-fracture osteoporosis therapy and specialist referrals.Conclusion This audit reveals substantial under-recognition and undertreatment of bone disease in cirrhosis, with poor adherence to national guidance despite clear risk indicators. As the first cycle of a quality improvement project, we propose implementing standardised bone health bundles at admission, discharge, and outpatient follow-up, alongside targeted clinician education and streamlined referral pathways. A re-audit will evaluate improvements in screening, treatment initiation, and adherence to BSG guidance. These interventions align with British Association for the Study of the Liver (BASL) priorities and offer a practical approach to reducing fragility fractures and improving outcomes in this high-risk population.",
  "authors": [
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Kuvira Munshi"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Kashika Rautray"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Laura Harrison"
    }
  ],
  "title": "P89 Silent fractures: under-recognition and suboptimal management of bone disease in cirrhosis",
  "uid": "b4bef5b3-6cc5-5bb2-b7b7-2e2dffd47427"
}