*Purpose: Although vital for preventing rejection, glucocorticoids contribute to post-operative morbidity, including osteoporosis. The primary purpose of this study was to identify the occurrence of osteopenia, osteoporosis, and known fracture at baseline and after lung transplant. A secondary objective was to benchmark the institution’s current osteoporosis prevention and treatment strategies against the 2017 recommendations from the American College of Rheumatology.

*Methods: This was a retrospective, single-center observational study. DEXA scans completed within 2.5 years prior to or after lung transplant were evaluated.

*Results: Patients who received a lung transplant between 01/01/2016 and 09/30/2018, and survived at least 1 year post-transplant were reviewed (n=48). Of those, 14 patients (29%) had both baseline and follow-up DEXA scans, and were thus evaluated for the primary endpoints. The average age at transplant was 55.9 + 13.3 years, 50% were male, 71% Caucasian, 21% Black, and 7% Asian. The primary indication for transplant was restrictive lung disease (57%), obstructive lung disease (36%), or cystic fibrosis (7%). One (7%) had a previous fracture and 11 (79%) had previous corticosteroid use. The time from baseline DEXA to transplant was 267 + 144 days, and from transplant to follow-up DEXA was 428 + 171 days. An average of 695 + 141 days passed between the baseline and follow-up DEXA scans. There was a significant decrease in femoral bone mineral density after lung transplant (p=0.003) but no significant change in spinal bone mineral density (p=0.18). Prior to transplant, 5 (36%) had osteopenia and 2 (14%) had osteoporosis. By 2.5 years post-transplant, 7 (50%) had osteopenia and 2 (14%) had osteoporosis. One patient developed a new fracture after transplant. There was no significant change in Fracture Risk Assessment Tool (FRAX) scores for either the overall ten-year fracture risk or the hip ten-year fracture risk. Concordance with the American College of Rheumatology (ACR) guidelines was poor. Of the patients with at least one DEXA scan on review, only 47% were on the correct treatment agents. Bisphosphonates or their alternatives (denosumab, teriparatide, raloxifene) were the agents most commonly indicated but not prescribed.

*Conclusions: The observed bone mineral density loss in this study may be a preventable adverse outcome. With a clear understanding of the magnitude of bone mineral density decrease and barriers to optimal treatment, practice advances to optimize bone health in lung transplant patients can be made.

« Back to 2020 American Transplant Congress