Unit of Endocrinology, Fondazione IRCCS Cà Granda- Ospedale Maggiore Policlinico, Padiglione Zonda, Via Francesco Sforza 35, Milan 20122, Italy.
Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
J Cyst Fibros. 2021 Nov;20(6):e100-e107. doi: 10.1016/j.jcf.2021.07.013. Epub 2021 Aug 6.
the effect of bone-active drugs on the risk of fragility fractures (Fx), bone mineral density (BMD) and trabecular bone score (TBS) changes in patients receiving lung transplantation (LTx) is largely unknown. This study assessed the bone-active drugs effect in patients undergoing LTx both with (CF) and without (nCF) cystic-fibrosis.
We evaluated incident Fx, both clinical and morphometric vertebral Fx by spinal X-ray, BMD and trabecular bone score (TBS) in 117 patients (CF=50, nCF n = 67) before and 24-months after LTx. A bone-active therapy was proposed to all LTx candidates.
83.8% of patients started a bone-active drug. Lumbar-spine (LS) T-score improved significantly only in treated patients (-1.4 ± 1.0 vs -2.0±1.0, p = 0.0001), whereas femur BMD and TBS remained stable in treated and not treated subjects. The rate of incident Fx was 15.3%, with no difference between treated and not treated patients. After LTx, LS T-score improved significantly only in nCF group (-1.3 ± 1.0 vs -1.8 ± 1.1, p = 0.0001), while femur remained stable in both nCF and CF groups. Patients with CF showed a significant Z-TBS increase (-3.6 ± 1.7 vs -3.0 ± 1.7, p = 0.019) and a lower Fx incidence as compared with nCF patients (4.1% vs 24.2%, p =0.003). Incident Fx were associated with nCF diagnosis (OR 7.300, CI95% 1.385-38.461, p = 0.019) regardless of prevalent Fx, previous glucocorticoid therapy and bone-active therapy introduced at least 6 months before LTx.
A prompt medical intervention helps in preventing BMD loss after LTx. As compared with nCF patients, CF patients show a TBS increase and a lower Fx risk after LTx.
骨活性药物对接受肺移植（LTx）的患者发生脆性骨折（Fx）、骨密度（BMD）和骨小梁评分（TBS）变化的影响在很大程度上尚不清楚。本研究评估了骨活性药物在伴有（CF）和不伴有（nCF）囊性纤维化的 LTx 患者中的作用。
我们评估了 117 例患者（CF=50 例，nCF=67 例）在 LTx 前和 24 个月后的新发 Fx，包括临床和形态计量学椎体 Fx 通过脊柱 X 射线、BMD 和骨小梁评分（TBS）。所有 LTx 候选者均被建议进行骨活性治疗。
83.8%的患者开始使用骨活性药物。只有在接受治疗的患者中，腰椎（LS）T 评分显著改善（-1.4±1.0 与-2.0±1.0，p=0.0001），而股骨 BMD 和 TBS 在治疗和未治疗的患者中保持稳定。新发 Fx 的发生率为 15.3%，治疗组和未治疗组之间无差异。LTx 后，仅在 nCF 组中 LS T 评分显著改善（-1.3±1.0 与-1.8±1.1，p=0.0001），而在 nCF 和 CF 两组中股骨均保持稳定。CF 患者的 Z-TBS 显著增加（-3.6±1.7 与-3.0±1.7，p=0.019），且与 nCF 患者相比，Fx 发生率较低（4.1%与 24.2%，p=0.003）。新发 Fx 与 nCF 诊断相关（OR 7.300，95%CI 1.385-38.461，p=0.019），与是否存在既往 Fx、既往糖皮质激素治疗以及至少在 LTx 前 6 个月开始的骨活性治疗无关。
及时的医疗干预有助于防止 LTx 后 BMD 丢失。与 nCF 患者相比，CF 患者在 LTx 后 TBS 增加，且 Fx 风险较低。
