Ferrari S L, Nicod L P, Hamacher J, Spiliopoulos A, Slosman D O, Rochat T, Bonjour J P, Rizzoli R
WHO Collaborative Center for Osteoporosis and Bone Disease, Dept of Internal Medicine, University Hospital, Geneva, Switzerland.
Eur Respir J. 1996 Nov;9(11):2378-82. doi: 10.1183/09031936.96.09112378.
The occurrence of osteoporotic fractures may seriously compromise the quality of life of lung transplant recipients. However, at present, the true risk of osteoporosis in such patients is unknown. We therefore prospectively evaluated bone mass changes in patients undergoing pulmonary transplantation. Bone mineral density (BMD) of lumbar spine (LS), femoral neck (FN) and femoral shaft (FS), as well as whole body bone mineral content (WB-BMC) were measured in 21 consecutive candidates for lung transplantation (9 males and 12 females; mean+/-SD age 47+/-11 yrs). Twelve of the patients had their BMD remeasured within 6 months after surgery, and nine again after 1 year. Before transplantation, BMD at all sites as well as WB-BMC were significantly decreased as compared to the values in young healthy adults, FN being the most affected (FN -25+/-2%; LS, -12+/-4%; FS -9+/-2%, WB-BMC -15+/-4% (mean+/-SEM)). Seven out of 20 adult patients (35%) fulfilled World Health Organization (WHO) criteria for osteoporosis, i.e. BMD more than 2.5 SD below peak bone mass, whereas three had previously been diagnosed as having osteoporotic fractures of the spine or femoral neck. Within 6 months after transplantation, significant bone loss occurred, mostly at the LS level (-4.0+/-1.7%; p=0.04), despite calcium and vitamin D supplementation. Furthermore, two patients had new osteoporotic vertebral fractures. After 1 year, no further bone loss or new osteoporotic fractures were observed. In conclusion, evaluation of bone mass and prevention of bone loss should be considered early before lung transplantation. Further studies are needed to determine the efficacy of antiresorptive drugs on the prevention of accelerated bone loss and vertebral fractures after transplantation.
骨质疏松性骨折的发生可能会严重影响肺移植受者的生活质量。然而，目前此类患者骨质疏松的真正风险尚不清楚。因此，我们对接受肺移植的患者的骨量变化进行了前瞻性评估。对21例连续的肺移植候选者（9例男性和12例女性；平均±标准差年龄47±11岁）测量了腰椎（LS）、股骨颈（FN）和股骨干（FS）的骨密度（BMD）以及全身骨矿物质含量（WB - BMC）。其中12例患者在术后6个月内重新测量了骨密度，9例在1年后再次测量。移植前，与年轻健康成年人的值相比，所有部位的骨密度以及全身骨矿物质含量均显著降低，股骨颈受影响最大（FN - 25±2%；LS，- 12±4%；FS - 9±2%，WB - BMC - 15±4%（平均±标准误））。20例成年患者中有7例（35%）符合世界卫生组织（WHO）骨质疏松症标准，即骨密度比峰值骨量低2.5个标准差以上，而3例之前被诊断为有脊柱或股骨颈骨质疏松性骨折。移植后6个月内，尽管补充了钙和维生素D，但仍发生了显著的骨质流失，主要发生在腰椎水平（- 4.0±1.7%；p = 0.04）。此外，有2例患者出现了新的骨质疏松性椎体骨折。1年后，未观察到进一步的骨质流失或新的骨质疏松性骨折。总之，在肺移植前应尽早考虑评估骨量和预防骨质流失。需要进一步研究以确定抗吸收药物对预防移植后加速骨质流失和椎体骨折的疗效。
