Ng Elisabeth, Kumar Shanal, Paul Eldho, Bennett Daniel, Rosi Luisa, Fuller Louise, Chiu Lauren, Sztal-Mazer Shoshana, Ivulich Steven, Snell Greg, Bach Leon A, Hackman Kathryn L
Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.
Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
JHLT Open. 2024 Nov 20;7:100182. doi: 10.1016/j.jhlto.2024.100182. eCollection 2025 Feb.
As life expectancy following lung transplantation (LT) improves, vulnerability to glucocorticoid-induced osteoporotic fractures is increased. Our institution offers LT recipients protocolized antiresorptive therapy, with zoledronic acid (ZA) used first line.
Adults who underwent LT from January 2012 to December 2018 and survived at least 6 months were retrospectively studied. Coprimary outcomes were incidence, prevalence, and predictors of osteoporotic fractures and major osteoporotic fractures post-LT.
Four hundred and five LT recipients (41% female, median age 59 years) had a median follow-up of 4.9 years (interquartile range 3.4-6.7). Osteoporotic fracture prevalence was 12% ( = 49) pre-LT and 15% ( = 60) post-LT. Major osteoporotic fracture post-LT occurred in 11% ( = 45). Antiresorptive therapy was received by 47% pre- and 89% post-LT. On multivariate analysis, risk factors for osteoporotic fracture were pre-LT osteoporotic fracture (hazard ratio (HR) 2.32 (95% confidence interval (CI) 1.09-4.96)), female sex (HR 2.08 (95% CI 1.09-3.94)), glucocorticoid use pre-LT (HR 2.08 (95% CI 1.09-3.99)), and time (months) to first ZA infusion post-LT (HR 1.04 (95% CI 1.01-1.06)). Risk factors for major osteoporotic fracture were pre-LT osteoporotic fracture, female sex, age, and time to first ZA infusion.
LT recipients receiving protocolized antiresorptive treatment post-LT had a low incidence of osteoporotic fracture.
随着肺移植（LT）后预期寿命的延长，糖皮质激素诱导的骨质疏松性骨折的易感性增加。我们机构为LT受者提供标准化的抗吸收治疗，唑来膦酸（ZA）作为一线用药。
对2012年1月至2018年12月接受LT且存活至少6个月的成年人进行回顾性研究。共同主要结局是LT后骨质疏松性骨折和主要骨质疏松性骨折的发生率、患病率及预测因素。
405例LT受者（41%为女性，中位年龄59岁）的中位随访时间为4.9年（四分位间距3.4 - 6.7年）。LT前骨质疏松性骨折患病率为12%（n = 49），LT后为15%（n = 60）。LT后主要骨质疏松性骨折发生率为11%（n = 45）。LT前47%、LT后89%的患者接受了抗吸收治疗。多因素分析显示，骨质疏松性骨折的危险因素为LT前骨质疏松性骨折（风险比（HR）2.32（95%置信区间（CI）1.09 - 4.96））、女性（HR 2.08（95% CI 1.09 - 3.94））、LT前使用糖皮质激素（HR 2.08（95% CI 1.09 - 3.99））以及LT后首次输注ZA的时间（月）（HR 1.04（95% CI 1.01 - 1.06））。主要骨质疏松性骨折的危险因素为LT前骨质疏松性骨折、女性、年龄以及首次输注ZA的时间。
LT后接受标准化抗吸收治疗的受者骨质疏松性骨折发生率较低。
