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Glucocorticoid-Induced Osteoporosis in Lung Transplant Patients

J. Clark, L. Potter

Department of Pharmacy, University of Chicago Medicine, Chicago, IL

Meeting: 2020 American Transplant Congress

Abstract number: C-297

Keywords: Adverse effects, Bone, Lung transplantation, Osteoporosis

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session C: Lung: All Topics

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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*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.

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To cite this abstract in AMA style:

Clark J, Potter L. Glucocorticoid-Induced Osteoporosis in Lung Transplant Patients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/glucocorticoid-induced-osteoporosis-in-lung-transplant-patients/. Accessed February 24, 2021.

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