Bone loss and fracture after lung transplantation

Background Osteoporosis is very common in patients with end-stage pulmonary disease. However, there are few prospective data on fracture incidence aft er lung transplantation. Methods. We prospectively evaluated changes in bone mass, fracture incidenc e, and biochemical indices of bone and mineral metabolism in 30 patients wh o completed 1 year of observation after lung transplantation. All received calcium, vitamin D, and therapy with one or more agents that inhibit bone r esorption, initiated shortly after transplantation. Results. Before transplantation, only 20% of the patients had normal lumbar spine (LS) and femoral neck bone mineral density (BMD). After transplantat ion, 15 patients (50%) sustained significant bone loss at either the LS (-8 .6+/-1.0%) or the femoral neck (-11.3+/-2.2%). Eleven (37%) patients (10 wo men) sustained a total of 54 atraumatic fractures. Pretransplantation LS BM D and T scores were significantly lower in those who sustained fractures (- 2.809+/-0.32 versus -1.569+/-0.29; P<0.01). Fracture patients were more lik ely to have had pretransplantation glucocorticoid therapy (chi-square 5.687 ; P<0.02). The duration of pretransplantation glucocorticoid therapy was al so longer in fracture patients (4.9+/-0.8 versus 1.3+/-0.4 years; P<0.001). Biochemical markers of bone resorption were significantly higher in patien ts who sustained bone loss and/or fractures. Conclusions. We conclude that fractures are a significant problem in the fi rst year after lung transplantation, even in patients who receive therapy t o prevent bone loss. Women with low pretransplantation BMD and a history of pretransplantation glucocorticoid therapy are at greatest risk.