Bone density is markedly reduced in lung transplant recipients; on average they are 2 standard deviations below age-matched reference ranges. Prospective studies showed loss of 4 to 4.8% in the first 6 months.
Fracture rate is high; in three prospective studies 10%,18% and 37% developed fractures in the first year. Patients continue to fracture for several years, and observational studies show 26, 35, and 42% incidence of vertebral compression fractures (the latter study included 60% of the transplant population, which were referred for evaluation, so the incidence could have been as low as 25%). The patients who fracture tend to have lower bone density values at the time of transplant.
Even when patients have received antiresorptive medications, the fracture rate and bone loss continue at high levels.
Osteocalcin is elevated. Parathyroid is high in some patients, and the vitamin D levels vary.
|Trinbetti||00||trial||1||42||spine z-score |
|25% in control, 5% Rx||.||14 given pamidronate 30 q 6mo|
|38%, same both groups||high resorption, better with pam.||pamidronate 30 q 6 mo|
hip - 4.7%
by 1 yr
|Shane||99||pros||1||30||half of patients lost |
|37%||Increased||Patients on antiresorptive Rx|
|33||z below -2 in 67% of pts|
|42%, timing throughout 3 yrs||hi ocalcin, hi PTH, low D, low test||60% of tx patients were in study|
|Haden||97a||xs||1 post tx||17||T -2.5 (age 42)||35%||PTH hi||.|
|Ferrari||96||pros||1||21||6 mo spine -4%||10% first yr||.||.|
|45||spine and hip z -2.3||26%||.||rx'd with ketoconazole|