Abstract
Introduction: Hepatocellular carcinoma (HCC) patients have a heightened prevalence of low bone mineral density (BMD) and the development of osteoporosis. Osteoporosis screening guidelines only recommend DEXA scans for females 65 and older and males 70 and older. We set out to analyze the incidence of low bone mineral density in HCC patients under 65 years old and encourage implementation of DEXA screenings for this patient population.
Method: In this retrospective cohort study, 170 patients under 65 years old with an HCC diagnosis were analyzed. The use of Hounsfield units (HU) from L1 non-contrast CT scans is a reliable predictor of T-scores from DEXA scans and was used to predict BMD in patients, with scores of less than 165 HU indicative of osteopenia and less than 98 indicative of osteoporosis.
Results: The median HU score of patients was 137.2, and the mean score was 142.6 (Min: 55.4; Max: 303.1). Approximately 75% of patients had an HU score of less than 165, indicating a high likelihood of suffering from low BMD. Approximately 20% of low BMD patients were identified as within a range of osteoporosis.
Conclusions: HCC patients under 65 have an increased incidence of bone demineralization. We suggest that BMD in HCC patients is an important prognostic tool and parameter to document, as studies have shown that HCC patients with high BMD have longer overall survival than patients with low BMD. Future prospective studies using DEXA scans to assess BMD should be completed to verify the risk of osteoporosis.