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Clinical Investigations: Miscellaneous |

Osteoporosis and Lung Transplantation*: A Prospective Study

Avrum Spira, MD; Carlos Gutierrez, MD; Cecilia Chaparro, MD; Michael A. Hutcheon, MD, FCCP; Charles K.N. Chan, MD, FCCP
Author and Funding Information

*From the Division of Respirology, Department of Medicine, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.

Correspondence to: Charles K.N. Chan, MD, FCCP, Head, Division of Respirology, The Toronto Hospital, General Division, 10-N220, Eaton Building, 200 Elizabeth St, Toronto, Ontario, M5G 2C4 Canada; e-mail: cchan@torhosp.toronto.on.ca



Chest. 2000;117(2):476-481. doi:10.1378/chest.117.2.476
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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.


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