Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia.
Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
J Clin Densitom. 2021 Oct-Dec;24(4):581-590. doi: 10.1016/j.jocd.2020.10.003. Epub 2020 Oct 21.
Osteoporosis is prevalent among lung transplant candidates and is exacerbated post-transplant by immunosuppressive therapy. Low bone mineral density (BMD) is a well-recognized surrogate for fragility fracture risk, which is associated with significant morbidity and mortality. Intravenous zoledronic acid (ZA) effectively reduces BMD loss and prevents fractures in postmenopausal osteoporosis. Many groups, ours included, prophylactically treat lung transplant recipients (LTR) with bisphosphonates, but no documented consensus currently exists. Our protocol comprises ZA every 6-months from transplant wait-listing, with interval reassessment to guide ongoing treatment. We evaluate the impact of a dose of ZA within 6 months of transplantation on BMD and fracture occurrence. A retrospective analysis was performed on all adult LTR from April 2012 to October 2014, of which 60 met our inclusion criteria. LTR who received ZA within 6 months of transplantation (n = 37) were compared to those who did not (n = 23), and followed up for a minimum of three years. Outcome measures were BMD change at the lumbar spine and femur (primary), and fracture occurrence (secondary). LTR treated with ZA within 6 months of transplantation experienced a median BMD change of +8.11% at the lumbar spine and +1.39% at the femur, compared to -1.20% and -3.92%, respectively, in LTR who did not receive a ZA dose within 6 months of transplantation (p = 0.002 & p = 0.008 respectively). Our findings indicate that prophylactic ZA within 6 months of transplantation prevents BMD loss in LTR.
骨质疏松症在肺移植候选者中很常见，并且在移植后会因免疫抑制治疗而加剧。低骨密度（BMD）是脆性骨折风险的公认替代指标，与重大发病率和死亡率相关。静脉唑来膦酸（ZA）可有效减少 BMD 流失并预防绝经后骨质疏松症的骨折。包括我们在内的许多团体都预防性地用双磷酸盐治疗肺移植受者（LTR），但目前尚无明确共识。我们的方案包括从移植等候名单开始每 6 个月使用 ZA，间隔评估以指导持续治疗。我们评估了移植后 6 个月内 ZA 剂量对 BMD 和骨折发生的影响。对 2012 年 4 月至 2014 年 10 月期间所有成年 LTR 进行了回顾性分析，其中 60 例符合我们的纳入标准。将在移植后 6 个月内接受 ZA 的 LTR（n=37）与未接受 ZA 的 LTR（n=23）进行比较，并随访至少 3 年。主要观察指标为腰椎和股骨的 BMD 变化（主要终点）和骨折发生（次要终点）。在移植后 6 个月内接受 ZA 治疗的 LTR 腰椎 BMD 变化的中位数为+8.11%，股骨为+1.39%，而未在 6 个月内接受 ZA 剂量的 LTR 分别为-1.20%和-3.92%（p=0.002 和 p=0.008）。我们的研究结果表明，移植后 6 个月内预防性使用 ZA 可防止 LTR 的 BMD 流失。
