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01-06-2021 | Liver Function Test | Concise Clinical Review

Peri-operative derangement in liver function tests in older patients with neck of femur fracture

Authors: J. Powell, A. Michael

Published in: Osteoporosis International | Issue 6/2021

Abstract

Neck of femur fracture is a common consequence of falls in the elderly with a large burden of morbidity and mortality. Derangement in liver function tests (LFTs) is frequently seen in elderly people with neck of femur (NOF) fracture in the peri-operative period and can indicate serious and treatable underlying pathology as well as prognosis.

On admission, raised alkaline phosphatase (ALP) levels with normal gamma-glutamyl transferase (GGT) suggest underlying bone pathology such as osteomalacia or Paget’s disease but do not confirm or exclude osteoporosis. ALP can also be raised by non-bone pathology such as congestive cardiac failure and chronic kidney disease. LFT derangement in cardiac failure is associated with poorer prognosis. Post-operatively, ALP levels rise after the first week with a peak at 3–4 weeks and then fall thereafter. The rate at which they fall may help indicate bone healing in trochanteric fractures. Derangement in other LFTs is commonly due to hepatic injury; causes include trauma, alcohol, and viral hepatitis. There are also iatrogenic causes including surgery and commonly prescribed medication such as beta-lactam antibiotics, non-steroidal anti-inflammatories, and paracetamol.

The differential diagnosis for deranged LFTs in the elderly peri-operatively is wide; however, most causes can be elicited through careful history and examination with occasional need for further investigations.

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Title: Peri-operative derangement in liver function tests in older patients with neck of femur fracture
Authors: J. Powell
A. Michael
Publication date: 01-06-2021
Publisher: Springer London
Keywords: Liver Function Test
Heart Failure
Paget's Disease of Bone
Osteomalacia
Osteoporosis
Osteoporosis
Osteomalacia
Published in: Osteoporosis International / Issue 6/2021
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-021-05827-4

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Peri-operative derangement in liver function tests in older patients with neck of femur fracture

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