Introduction

the effect of bone-active drugs on the risk of fragility fractures (Fx), bone mineral density (BMD) and trabecular bone score (TBS) changes in patients receiving lung transplantation (LTx) is largely unknown. This study assessed the bone-active drugs effect in patients undergoing LTx both with (CF) and without (nCF) cystic-fibrosis.

Methods

We evaluated incident Fx, both clinical and morphometric vertebral Fx by spinal X-ray, BMD and trabecular bone score (TBS) in 117 patients (CF=50, nCF n = 67) before and 24-months after LTx. A bone-active therapy was proposed to all LTx candidates.

Results

83.8% of patients started a bone-active drug. Lumbar-spine (LS) T-score improved significantly only in treated patients (-1.4 ± 1.0 vs -2.0±1.0, p = 0.0001), whereas femur BMD and TBS remained stable in treated and not treated subjects. The rate of incident Fx was 15.3%, with no difference between treated and not treated patients. After LTx, LS T-score improved significantly only in nCF group (-1.3 ± 1.0 vs -1.8 ± 1.1, p = 0.0001), while femur remained stable in both nCF and CF groups. Patients with CF showed a significant Z-TBS increase (-3.6 ± 1.7 vs -3.0 ± 1.7, p = 0.019) and a lower Fx incidence as compared with nCF patients (4.1% vs 24.2%, p =0.003). Incident Fx were associated with nCF diagnosis (OR 7.300, CI95% 1.385–38.461, p = 0.019) regardless of prevalent Fx, previous glucocorticoid therapy and bone-active therapy introduced at least 6 months before LTx.

Conclusions

A prompt medical intervention helps in preventing BMD loss after LTx. As compared with nCF patients, CF patients show a TBS increase and a lower Fx risk after LTx.

中文翻译：

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骨活性药物和潜在疾病对肺移植后骨骼健康的影响：一项纵向研究

介绍

骨活性药物对接受肺移植 (LTx) 患者的脆性骨折 (Fx)、骨矿物质密度 (BMD) 和小梁骨评分 (TBS) 变化风险的影响在很大程度上是未知的。本研究评估了在患有 (CF) 和不患有 (nCF) 囊性纤维化的患者中接受 LTx 的骨活性药物的作用。

方法

我们在 LTx 之前和之后 24 个月对 117 名患者 (CF=50, nCF n  = 67) 进行了脊柱 X 线、BMD 和骨小梁评分 (TBS) 的事件 Fx、临床和形态测量椎骨 Fx 评估。建议对所有 LTx 候选者进行骨活性治疗。

结果

83.8% 的患者开始使用骨活性药物。腰椎 (LS) T 评分仅在接受治疗的患者中显着改善（-1.4 ± 1.0 对比 -2.0±1.0，p  = 0.0001），而股骨 BMD 和 TBS 在接受治疗和未接受治疗的受试者中保持稳定。Fx 的发生率为 15.3%，接受治疗和未接受治疗的患者之间没有差异。LTx 后，LS T分数仅在 nCF 组中显着改善（-1.3 ± 1.0 vs -1.8 ± 1.1，p  = 0.0001），而股骨在 nCF 和 CF 组中均保持稳定。与 nCF患者相比，CF 患者的Z -TBS 显着增加（-3.6 ± 1.7 vs -3.0 ± 1.7，p  = 0.019）和较低的 Fx 发生率（4.1% vs 24.2%，p=0.003)。事件 Fx 与 nCF 诊断相关（OR 7.300，CI95% 1.385–38.461，p  = 0.019），无论流行的 Fx、先前的糖皮质激素治疗和在 LTx 前至少 6 个月引入的骨活性治疗如何。

结论

及时的医疗干预有助于防止 LTx 后的 BMD 损失。与 nCF 患者相比，CF 患者在 LTx 后显示 TBS 增加和较低的 Fx 风险。