Trombetti A, Gerbase M W, Spiliopoulos A, Slosman D O, Nicod L P, Rizzoli R
Division of Bone Diseases,a WHO Collaborating Center for Osteoporosis and Bone Diseases, University Hospital of Geneva, Switzerland.
J Heart Lung Transplant. 2000 Aug;19(8):736-43. doi: 10.1016/s1053-2498(00)00132-7.
Lung-transplant recipients are at risk of osteoporosis. They may have low bone mass even before posttransplantation immunosuppressive therapy. We studied bone mineral density (BMD) before and after lung transplantation and compared the efficacy of antiresorptive therapies to calcium and vitamin D supplementation.
Areal BMD was assessed in 42 patients awaiting lung transplantation and measured again after surgery at 6 (n = 29), and at 12 months (n = 20). Nineteen patients received antiresorptive therapy (30 mg pamidronate IV every 3 months (n = 14), or hormonal replacement therapy (n = 5)), and 10 patients received only calcium and vitamin D supplements.
Mean age- and gender-adjusted lumbar spine (LS) and femoral neck (FN) BMD was significantly decreased prior to transplantation (- 0.6 +/- 0.2, p< 0.01, and - 1.5 +/- 0.2 standard deviation, p < 0.001, respectively). At that time, 29% were osteoporotic (T-score < - 2.5 below the peak bone mass), while 55% were below - 1.0 T-score. Antiresorptive therapy decreased the rate of LS bone loss during the first 6 months and led to a significant increase of BMD at 1 year, with LS changes of + 0.2 +/- 0.1 vs - 0.4 +/- 0.1 Z-score in the calcium-vitamin D group (p< 0.002), and + 0.2 +/- 0.1 vs - 0.04 +/- 0.1 for FN (NS). One out of 20 patients experienced clinically evident fractures during antiresorptive therapy, and 3 out of 12 in the calcium-vitamin D group.
A significant proportion of patients awaiting lung transplantation was osteoporotic or osteopenic. Antiresorptive therapy (pamidronate or hormone-replacement therapy (HRT)) prevented accelerated LS bone loss after graft.
肺移植受者有患骨质疏松症的风险。即使在移植后免疫抑制治疗之前，他们的骨量可能就已经较低。我们研究了肺移植前后的骨矿物质密度（BMD），并比较了抗吸收疗法与补充钙和维生素D的疗效。
对42例等待肺移植的患者进行了面积骨密度评估，并在术后6个月（n = 29）和12个月（n = 20）再次测量。19例患者接受了抗吸收治疗（每3个月静脉注射30 mg帕米膦酸盐（n = 14），或激素替代疗法（n = 5）），10例患者仅接受钙和维生素D补充剂。
移植前，经年龄和性别调整后的平均腰椎（LS）和股骨颈（FN）骨密度显著降低（分别为-0.6±0.2，p<0.01，和-1.5±0.2标准差，p<0.001）。当时，29%的患者患有骨质疏松症（T评分低于峰值骨量-2.5以下），而55%的患者T评分低于-1.0。抗吸收治疗在最初6个月降低了LS骨丢失率，并导致1年后骨密度显著增加，LS变化在钙-维生素D组为+0.2±0.1 vs -0.4±0.1 Z评分（p<0.002），FN为+0.2±0.1 vs -0.04±0.1（无显著性差异）。20例接受抗吸收治疗的患者中有1例在治疗期间发生了临床明显的骨折，钙-维生素D组12例中有3例。
相当一部分等待肺移植的患者患有骨质疏松症或骨质减少症。抗吸收治疗（帕米膦酸盐或激素替代疗法（HRT））可防止移植后LS骨丢失加速。
