# The Incidence of Osteoporosis in Hepatocellular Carcinoma Patients Under 65: A Retrospective Cohort Study

## TL;DR

This study finds that many HCC patients under 65 have low bone density, suggesting the need for earlier osteoporosis screening.

## Contribution

The study highlights the high incidence of low BMD in HCC patients under 65, advocating for earlier DEXA screening in this population.

## Key findings

- 75% of HCC patients under 65 had HU scores indicating low BMD.
- 20% of low BMD patients were in the osteoporosis range.
- Low BMD in HCC patients is linked to shorter overall survival.

## 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 dual-energy X-ray absorptiometry (DEXA) scans for females 65 and older and males 70 and older. We set out to analyze the incidence of low BMD 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 with an HCC diagnosis were analyzed. Hounsfield units (HU) from L1 non-contrast CT scans are a reliable predictor of T-scores from DEXA scans and were 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 (minimum: 55.4; maximum: 303.1). Of the total 170 patients, 128 (75%) had an HU score of less than 165, indicating a high likelihood of suffering from low BMD. Among low BMD patients, 25 (20%) 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.