Chest
Volume 117, Issue 2, February 2000, Pages 476-481
Journal home page for Chest

Clinical Investigations
Osteoporosis and Lung Transplantation: A Prospective Study

https://doi.org/10.1378/chest.117.2.476Get rights and content

Study objective

Osteoporosis is a well-recognized complication of lung transplantation that may significantly impair the quality of life of transplant recipients. We performed a prospective study of bone mineral density (BMD) before and after transplantation to determine the degree of bone mass loss associated with lung transplantation

Patients and design

We conducted a prospective study of BMD in 28 patients with various end-stage respiratory diseases pretransplantation and 6 to 12 months posttransplantation. The BMD of the lumbar spine (LS) and femoral neck (FN) were measured. All 28 patients were treated only with vitamin D and calcium supplementation posttransplant. The primary endpoint was the percentage change in BMD. The secondary endpoint was the incidence of fractures posttransplant. A univariate analysis was conducted to determine the various risk factors associated with bone mass loss pretransplant and posttransplant.

Results

Prior to transplantation, moderate to severe bone disease was evident. The mean (± SD) pretransplant T score (the number of SDs from the peak bone mass) and Z score (the number of SDs from the age-matched mean) for the LS were −1.72 ± 1.37 and −1.44 ± 1.31, respectively. The mean pretransplant T score and Z score for the FN were −2.65 ± 1.01 and− 1.5 ± 1.43, respectively. Within 6 to 12 months posttransplant, the mean BMD for the LS decreased by 4.76% (p < 0.001), while the mean BMD for the FN decreased by 5.3% (p < 0.001). Five of the 28 patients (18%) suffered osteoporotic fractures posttransplant, while no fractures were documented pretransplant. The cumulative steroid dose posttransplant was associated with a drop in BMD for the LS and FN (r = 0.39, p = 0.039 and r = 0.63, p < 0.001, respectively), while a negative association was found between cumulative steroid use pretransplant and baseline LS and FN T scores (r = −0.4, p = 0.02 and r = −0.43, p = 0.023, respectively).

Conclusion

Within 6 to 12 months after lung transplantation, there is a significant decrease in BMD at both the LS and FN levels (approximately 5%) despite vitamin D and calcium supplementation. This drop in BMD is associated with a relatively high incidence of osteoporotic fractures posttransplant.

Section snippets

Study Patients

All patients who underwent transplantation at the Toronto Hospital between June 12, 1996, and February 21, 1998, who survived a minimum of 6 months post-lung transplant were eligible for our study. Forty patients underwent transplantation during the study period, and 9 patients died within 6 months of transplantation. We were unable to obtain the pretransplant BMD on 3 of the 31 eligible patients (9.6%).

The BMD of the LS and FN of 28 patients was measured pretransplant (mean, 4.9 months prior

Results

The median age of the 28 patients (16 men and 12 women) enrolled in our study was 53.5 years (range, 21 to 67 years). Pretransplant demographics, broken down by underlying lung disease, are illustrated in Table 1.

Moderate to severe bone disease was evident pretransplantation. The mean (± SD) pretransplant BMD of the LS was 0.821 ± 0.168 g/cm2 with mean Z and T scores of −1.44 ± 1.5 and −1.72 ± 1.37, respectively. The mean pretransplant BMD of the FN was 0.632 ± 0.108 g/cm2 with mean Z and T

Discussion

Our study demonstrated a statistically significant drop in BMD at both the LS (4.76%) and the FN (5.3%) within 6 to 12 months posttransplantation, despite prophylactic treatment with vitamin D and calcium. The only other prospective study in this area, which was conducted by Ferrari et al18 with 12 patients (all treated with vitamin D and calcium alone), found a BMD loss of 4% at the LS within 3 to 6 months posttransplant, with no statistically significant loss at the FN. The drop in BMD in our

References (29)

  • AlmondMK et al.

    Loss of regional bone mineral density in the first 12 months following renal transplantation

    Nephron

    (1994)
  • SambrookPN et al.

    Bone loss after cardiac transplantation: a prospective study

    J Heart Lung Transplant

    (1994)
  • MuchmooreJS et al.

    Loss of vertebral bone density in heart transplant patients

    Transplant Proc

    (1991)
  • SambrookPN et al.

    Mechanisms of rapid bone loss following cardiac transplantation

    Osteoporos Int

    (1994)
  • Cited by (0)

    View full text