Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*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.
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 May 18, 2021.
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