Background: fragility fractures (FX) occur frequently after lung transplantation (TX), with a higher rate (15-20%) in the first two years, which decreases subsequently. Patients affected from cystic fibrosis (CF) seem to have a lower FX risk in the first two years after TX as compared with those affected with other lung diseases (nCF). The aim of our study is to evaluate and compare the long-term skeletal outcome in CF and nCF patients after TX.
Methods: we evaluated the FX rate and the trend in bone mineral density (BMD) after the first two years post-TX in 67 patients (36 CF, 31 nCF). The mean follow-up duration was 5.4 (4-8) years and 37.3% patients (15% CF e 51.6% nCF,P=0.023) was taking bisphosphonates.
Results: 2/67 patients (3%), both with TX rejection, had FX (1 FC 28 years old with hip FX and 1 nFC 65 years old with wrist FX). Lumbar spine (LS) BMD remained stable in both groups (-1.3±1.1 vs -1.1±1.1,P=0.081) and (-1.5±1.0 vs -1.4±1.1,P=0.485, CF and nCF respectively). Femoral neck (FN) and total hip (TH) BMD improved in CF group (-1.8±1.0 vs -1.6±0.9,P=0.036; -1.6±0.9 vs -1.4±0.8,P=0.001; respectively, FN, TH), conversely, FN worsened significantly and TH remained stable in nCF group (-1.7±0.8 vs -1.9±0.6,P=0.018; -1.3±0.7 vs -1.3±0.7,P=0.666; FN and TH respectively), in spite of a higher percentage of nCF patients taking bisphosphonates. The nCF disease was significantly associated with a worsening in both FN (OR 30.3P=0.017, 95%CI 1.8-500) and LS BMD (OR 11.5P=0.027, 95%CI 1.3-100) regardless of ongoing bisphosphonates therapy, cumulative glucocorticoids dose, age, TX rejection, spine deformity index.
Conclusions: our study confirms a low FX rate after the first two years post-TX. Also the long-term data suggest that the skeletal outcome after TX is more favourable in CF patients.
21 May 2022 - 24 May 2022