Caffarelli Carla, Gonnelli Stefano, Tomai Pitinca Maria Dea, Francolini Valentina, Fui Annalisa, Bargagli Elena, Refini Rosa Metella, Bennett David, Nuti Ranuccio, Rottoli Paola
UOC Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
UOC Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Intern Emerg Med. 2016 Dec;11(8):1087-1094. doi: 10.1007/s11739-016-1501-z. Epub 2016 Jul 8.
Idiopathic pulmonary fibrosis (IPF) is a rare form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. The aim of this cross-sectional study was to assess the prevalence of osteoporosis and fragility fracture in a population of adults with IPF and to identify whether any possible clinical and pulmonary function parameters may be associated with increased bone fragility. In 58 IPF patients (mean age 65.1 ± 9.1 years), we measured bone mineral density (BMD) of the lumbar spine, the femoral neck, and the entire hip. Moreover, the presence of vertebral fractures on a lateral chest X-ray study was evaluated, and a vertebral fracture burden was quantified using the spinal deformity index (SDI). As expected, osteoporosis was significantly more frequent in females with respect to males (57.9 vs 20.5 %, respectively), whereas the fractures prevailed in males with respect to females (38.5 vs 26.3 %, respectively). There were positive correlations between BMD at all skeletal sites and respiratory parameters; in particular for FVC % and DLCO % with BMD at femoral sub-regions. Moreover, we compared the average of DLCO (%) measure by values of SDI score that was higher in those patients with lower values of DLCO (%). The study shows a high prevalence of fragility with vertebral fractures in IPF patients, especially in males. Moreover, the vertebral fracture burden is associated with a worsening of FVC (%) and DLCO (%). Therefore, an evaluation of bone status is recommended, especially in those patients who are candidates for lung transplantation.
特发性肺纤维化（IPF）是一种病因不明的罕见慢性进行性纤维化间质性肺炎。这项横断面研究的目的是评估成年IPF患者中骨质疏松症和脆性骨折的患病率，并确定是否有任何可能的临床和肺功能参数与骨脆性增加有关。在58例IPF患者（平均年龄65.1±9.1岁）中，我们测量了腰椎、股骨颈和全髋部的骨密度（BMD）。此外，通过胸部X线侧位片评估椎体骨折的存在情况，并使用脊柱畸形指数（SDI）对椎体骨折负荷进行量化。正如预期的那样，女性骨质疏松症的发生率显著高于男性（分别为57.9%和20.5%），而骨折发生率男性高于女性（分别为38.5%和26.3%）。所有骨骼部位的骨密度与呼吸参数之间存在正相关；特别是用力肺活量（FVC）%和一氧化碳弥散量（DLCO）%与股骨亚区域的骨密度。此外，我们比较了根据SDI评分值测量的DLCO（%）平均值，DLCO（%）值较低的患者SDI评分较高。该研究表明，IPF患者中脆性骨折的患病率很高，尤其是男性。此外，椎体骨折负荷与FVC（%）和DLCO（%）的恶化有关。因此，建议对骨状态进行评估，尤其是对于那些有肺移植候选资格的患者。
