SEVERE OSTEOPOROSIS BEFORE AND AFTER LUNG TRANSPLANTATION

Study objective: Osteoporosis and/or fractures have been reported as a complication of kidney, heart, liver, bane marrow, and, most recently , lung transplantation (LTx). We measured bone mineral density (BMD) b efore and after LTx to determine the frequency and severity of preoper ative and postoperative osteoporosis. Patients and methods: We conduct ed a cross-sectional study of BMD in 100 patients with various diagnos es before (n=55) and after (n=45) LTx. Results: Age-matched mean spine and femoral BMDs were severely depressed before and after LTx placing 45% of the pre-LTx and 73% of the post-LTx patients at or below the f racture threshold (2 SDs below the mean). As expected, patients with c ystic fibrosis had lower (p<0.05) mean spine and femoral BMD than pati ents with COPD or other lung diseases both before and after LTx. Never theless, considerable osteoporosis was present in the patients with CO PD and other lung diseases before and after LTx. The best predictors o f pre- and post-LTx Z scores were body mass index: (r=0.56 to 0.59, p< 0.001) and cumulative steroid dose/per kilogram (r=0.49-0.51, p<0.001) , respectively. Osteoporosis has resulted in 3 symptomatic fractures b efore and 12 after LTx. Conclusions: Osteoporosis appears to be widesp read in patients with end-stage respiratory failure before LTx and LTx , while often life-saving, has an adverse impact on BMD. As patients l ive longer after LTx, osteoporosis-related fractures may compromise qu ality of life by causing pain and debilitation.