Highlights
- •Data on bone health following lung transplantation in patients with cystic fibrosis is limited.
- •In this study, we compared bone mineral density changes and fracture incidence post-lung transplantation in patients with vs. without cystic fibrosis.
- •Despite lower pre-transplantation BMD, CF patients exhibit better BMD recovery post-transplantation.
- •Post-lung transplantation, fractures occurred in 30% and 34% of CF and non-CF patients, respectively.
- •Lower pre-transplantation BMD and FEV1% are associated with greater fracture incidence post-transplantation.
Abstract
Background
Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF). Although
lung transplantation (LTx) improves quality of life of CF patients, there is little
research examining long-term bone health outcomes following LTx in these patients.
Methods
Data were collected on 59 patients who underwent LTx between 2006 and 2019, including
30 with CF and 29 without CF. We compared baseline characteristics, long-term bone
mineral density (BMD) trends, and fracture incidence between the two patient populations,
and examined factors associated with post-LTx fractures in CF patients.
Results
Compared with non-CF patients, patients with CF were younger, had lower body mass
index, and lower baseline BMD Z-scores at the lumbar spine, femoral neck, and total
hip (all p<0.001). BMD at all sites declined in both groups in the first year post-LTx. In subsequent
years, CF patients exhibited better BMD recovery relative to pre-transplantation,
but continued to have lower BMD post-LTx. Post-transplant fractures occurred in 30%
and 34% of CF and non-CF patients, respectively. CF patients who developed fractures
after LTx had significantly lower BMD and lower pre-transplantation percent predicted
forced expiratory volume in one second (FEV1%).
Conclusions
Although CF patients exhibit better BMD recovery following LTx compared to their non-CF
counterparts, CF patients start with significantly lower pre-LTx BMD and experience
a similarly high rate of post-LTx fractures. These findings highlight the unique contribution
of the CF disease process to bone health, as well as a clear need for better prevention
and treatment of osteoporosis in CF patients before and after LTx.
Keywords
Abbreviations:
BMD (bone mineral density), CF (cystic fibrosis), CFTR (cystic fibrosis transmembrane conductance regulator), DXA (dual-energy x-ray absorptiometry), eGFR (estimated glomerular filtration rate), FEV1 (forced expiratory volume in one second), FEV1% (percent predicted forced expiratory volume in one second), FVC (forced vital capacity), LTx (lung transplantation), PFT (pulmonary function test), 6MWD (6-minute walk distance)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 18, 2023
Accepted:
January 11,
2023
Received in revised form:
December 22,
2022
Received:
June 26,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
