Spira A, Gutierrez C, Chaparro C, Hutcheon M A, Chan C K
Division of Respirology, Department of Medicine, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.
Chest. 2000 Feb;117(2):476-81. doi: 10.1378/chest.117.2.476.
Osteoporosis is a well-recognized complication of lung transplantation that may significantly impair the quality of life of transplant recipients. We performed a prospective study of bone mineral density (BMD) before and after transplantation to determine the degree of bone mass loss associated with lung transplantation Patients and design: We conducted a prospective study of BMD in 28 patients with various end-stage respiratory diseases pretransplantation and 6 to 12 months posttransplantation. The BMD of the lumbar spine (LS) and femoral neck (FN) were measured. All 28 patients were treated only with vitamin D and calcium supplementation posttransplant. The primary endpoint was the percentage change in BMD. The secondary endpoint was the incidence of fractures posttransplant. A univariate analysis was conducted to determine the various risk factors associated with bone mass loss pretransplant and posttransplant.
Prior to transplantation, moderate to severe bone disease was evident. The mean (+/- SD) pretransplant T score (the number of SDs from the peak bone mass) and Z score (the number of SDs from the age-matched mean) for the LS were -1.72 +/- 1.37 and -1.44 +/- 1.31, respectively. The mean pretransplant T score and Z score for the FN were -2.65 +/- 1.01 and -1.5 +/- 1.43, respectively. Within 6 to 12 months posttransplant, the mean BMD for the LS decreased by 4.76% (p < 0.001), while the mean BMD for the FN decreased by 5.3% (p < 0.001). Five of the 28 patients (18%) suffered osteoporotic fractures posttransplant, while no fractures were documented pretransplant. The cumulative steroid dose posttransplant was associated with a drop in BMD for the LS and FN (r = 0.39, p = 0.039 and r = 0.63, p < 0.001, respectively), while a negative association was found between cumulative steroid use pretransplant and baseline LS and FN T scores (r = -0.4, p = 0. 02 and r = -0.43, p = 0.023, respectively).
Within 6 to 12 months after lung transplantation, there is a significant decrease in BMD at both the LS and FN levels (approximately 5%) despite vitamin D and calcium supplementation. This drop in BMD is associated with a relatively high incidence of osteoporotic fractures posttransplant.
骨质疏松是肺移植公认的并发症，可能会显著损害移植受者的生活质量。我们对移植前后的骨密度（BMD）进行了一项前瞻性研究，以确定与肺移植相关的骨质流失程度。
我们对28例患有各种终末期呼吸系统疾病的患者在移植前及移植后6至12个月进行了BMD的前瞻性研究。测量了腰椎（LS）和股骨颈（FN）的骨密度。所有28例患者移植后仅接受维生素D和钙补充治疗。主要终点是BMD的百分比变化。次要终点是移植后骨折的发生率。进行单因素分析以确定移植前和移植后与骨质流失相关的各种风险因素。
移植前，中度至重度骨病明显。移植前LS的平均（±标准差）T评分（与峰值骨量的标准差数）和Z评分（与年龄匹配平均值的标准差数）分别为-1.72±1.37和-1.44±1.31。移植前FN的平均T评分和Z评分分别为-2.65±1.01和-1.5±1.43。在移植后6至12个月内，LS的平均BMD下降了4.76%（p<0.001），而FN的平均BMD下降了5.3%（p<0.001）。28例患者中有5例（18%）在移植后发生骨质疏松性骨折，而移植前未记录到骨折。移植后累积类固醇剂量与LS和FN的BMD下降相关（r=0.39，p=0.039和r=0.63，p<0.001），而移植前累积类固醇使用量与基线LS和FN T评分之间存在负相关（r=-0.4，p=0.02和r=-0.43，p=0.023）。
肺移植后6至12个月内，尽管补充了维生素D和钙，但LS和FN水平的BMD仍显著下降（约5%）。这种BMD下降与移植后骨质疏松性骨折的相对高发生率相关。
