Original articleBone mineral density in lung-transplant recipients before and after graft: prevention of lumbar spine post-transplantation-accelerated bone loss by pamidronate
Section snippets
Patients
Between January 1993 and January 1999, we prospectively studied 42 adults awaiting lung transplantation ranging in age from 17 to 64 years (average age 46.0 ± 1.8 years of age). There were 22 men, 12 postmenopausal women, and 8 premenopausal women. The majority of patients suffered from either chronic obstructive pulmonary disease (COPD) or CF. Nineteen patients were receiving antiosteoporosis therapy either with calcium alone (n = 1); calcium and vitamin D (n = 9); estroprogestagens (n = 8),
Laboratory measurements
Plasma and urinary calcium, phosphate, and creatinine were measured. Plasma calcium was adjusted for protein levels (adjusted Ca = Ca/[(protein/160) + 0.55]). Urinary calcium/creatinine was taken as a reflection of net bone resorption. Osteocalcin, which is a marker of bone formation and turnover, was determined with an immunoradiometric assay (CIS-Bio, Gif-sur-Yvette, France). Urinary deoxypyridinoline, which is a specific marker of bone resorption, was measured by fluorescence emission after
Statistical analysis
All data are expressed as mean ± SEM. The statistical significance of the differences was assessed by a two-tailed Student’s t-test and an analysis of variance (ANOVA) for intergroup comparison. A paired Student’s t-test and a Mann Whitney test were used for intragroup comparison. A p value of less than 0.05 was considered significant.
Before transplantation
Recorded risk factors for osteoporosis before lung transplantation were menopause, history of glucocorticoid therapy, or tobacco use (Table I). Forty-three percent of the patients were receiving calcium and vitamin D, and/or hormone replacement. In patients awaiting lung transplantation, mean age- and gender-adjusted LS and FN BMD (Z-scores) was significantly decreased (LS: − 0.6 ± 0.2 SD, P< 0.01; FN: − 1.5 ± 0.2 SD, P< 0.001) (Table II). Twenty-nine percent were osteoporotic with a value at
Discussion
Lung-transplant recipients have typically low bone mass and an increased risk of osteoporotic fractures that could impair their quality of life and graft function.3, 10, 13, 14, 15 Since their low bone mass results from the amount present before transplantation and lost thereafter, we compared age- and gender-adjusted BMD at time of transplant and postoperatively.
The population studied was similar to that as previously reported by Shane et al. with 40% of patients suffering from COPD and 16%
Acknowledgements
The authors thank the teams of the Transplantation Unit and of the Division of Nuclear Medicine for patient care. This work was supported by a grant from the Swiss National Science Foundation (Grant No. 32-49757.96). The authors appreciate the contribution of Dr S. Ferrari, MD, in the initial part of this study.
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