Effect of Prophylactic Treatment of Osteoporosis on the Progression of Bone Mineral Density and Fractures in Lung Transplant Recipients – A Five-Year, Single-Center Experience
1Transplant nephrology, Ohio State University, Columbus, OH, 2Transplant nephrology, The Ohio State University, Columbus, OH
Meeting: 2022 American Transplant Congress
Abstract number: 336
Keywords: Bone, Lung, Osteoporosis, Risk factors
Topic: Clinical Science » Lung » 64 - Lung: All Topics
Session Information
Session Name: Early and Late Outcomes in Lung Transplantation
Session Type: Rapid Fire Oral Abstract
Date: Monday, June 6, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:00pm-6:10pm
Location: Hynes Room 210
*Purpose: The incidence of osteoporotic fractures in lung transplant recipients (LTxR) is 35-50%. Due to this high incidence, we perform regular DEXA scans [pre-Tx, every two years post-Tx], calcium/vitamin D repletion, and universal bisphosphonate administration. Our retrospective study aims to assess the effects of this strategy on pre-and post-transplant BMD and incidence of fractures.
*Methods: We conducted a retrospective, single-center study on 203 adults with LTx performed between 2015-2020 and meeting the inclusion/exclusion criteria. Primary endpoints – changes in BMD, the incidence of fractures, and osteopenia in the pre-and post-transplant groups. In addition, we assessed the side-effects of bisphosphonate therapy and risk factors for osteoporosis as secondary outcomes.
*Results: Bisphosphonates were initiated at the discharge from the index stay. LTxR with established osteoporosis was started either on alendronate 70mg weekly [CrCl more than 35] and on denosumab 60mg q 6 months [CrCl less than 35]. In contrast, osteopenic received a lower dose of alendronate [35 mg weekly]. Median follow-up was 1034 days [185, 2348]. 85% of the recipients were Caucasians with a median age of 61 years [23, 75] and an average BMI of 14.4 kg/m2. Idiopathic pulmonary fibrosis [38%], COPD [34%], cystic-fibrosis [5.6%] were the commonest etiologies for LTx. Risk factors such as Age >50 years [88%, 178/203], smoking [75%, 152/203], episode of rejection [62%, 126/203], female gender [42%, 85/203], menopause [40%, 81/203], BMI of < 23 kg/m2 [29%, 59/203], hypovitaminosis D (<20ng/mL,26/203, 13%) were common. 81% of patients with ≥ 3 risks had an episode of post-transplant fractures. Prevalence of pre-transplant osteopenia [T score < - 1] in the lumbar region was 39% and improved to 23% post-transplant with the bisphosphonate therapy. Similarly, the prevalence of osteopenia in the hip region improved from 47% pretransplant to 41% post-transplant. Approximately 16% of recipients had a history of pre-transplant fractures. 14% of recipients had new, and 2% had additional post-transplant fractures despite bisphosphonate therapy. Both Lumbar BMD [0.04 gm/cm2 (-0.001, 0.09), p-value 0.054] and Hip BMD [-0.01 +/- 0.02 gm/cm2 (-0.04 to 0.03), p-value 0.7] stayed preserved during the follow-up period, and the difference in the median was not statistically significant. Vertebral, ankle, and femoral were the commonest fracture sites. More than 95% of patients were on calcium/vitamin D supplements. Cumulative steroid exposure (prednisone) was 461mg [0, 17015] but the dose was not predictive for fractures. GI side effects were commonest (4%), followed by jaw pain (0.4%) and stress fracture (0.8%).
*Conclusions: LTxR is at high risk for osteoporotic fractures and causes significant morbidity. Preventive strategies such as treating with bisphosphonate can help stabilize the BMD and decrease the fracture risk.
To cite this abstract in AMA style:
Singh P, Ross A, Mejia J, Pesavento TE, Meng S. Effect of Prophylactic Treatment of Osteoporosis on the Progression of Bone Mineral Density and Fractures in Lung Transplant Recipients – A Five-Year, Single-Center Experience [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-prophylactic-treatment-of-osteoporosis-on-the-progression-of-bone-mineral-density-and-fractures-in-lung-transplant-recipients-a-five-year-single-center-experience/. Accessed October 10, 2024.« Back to 2022 American Transplant Congress