Session Information
Date: Sunday, November 13, 2016
Title: Osteoporosis and Metabolic Bone Disease – Clinical Aspects and Pathogenesis - Poster
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with a terminal lung disease have a great number of risk factors for the development of osteoporosis. Although much has been learned about the factors that contribute to bone mass loss, in our study we try to determine the risk factors in groups of similar diseases. The study´s objective is to determine if the known risk factors for low bone mass are more prevalent in each of the studied lung diseases and if these correlate with the presence of osteoporosis in lung transplantation candidates.
Methods: 179 patients were included, from the cohort of lung transplant patients of the Vall d’Hebron Univesity Hospital, whose pre transplant bone densitometry at lumbar spine and femoral neck were available. 3 groups of lung diseases were selected, due to the differences related to the grouping of risk factors and the glucocorticosteroid doses required before transplantation. The groups were: Chronic Obstructive Pulmonary Diseases (COPD), Interstitial Lung Diseases (ILD) and Other Diseases (Lymphangioleiomyomatosis, cystic fibrosis, primary and secondary pulmonary hypertension). The glucocorticosteroid dose was stratified as follows: high dose if it was more than 5mg/day for more than 3 months (or prednisone equivalent) or more than 3 times a year, and low dose if it didn’t meet these conditions.
Results: 179 patients were included, with an average age of 51±10.4 years, without sex related differences. 69 were women (66% of them were at menopause at the moment of the transplantation). 12.3% (22 patients) of the patients had a low body mass index, 57% were smokers with an average of 24.7 packages/year, 5% consumed more than 40 grams of alcohol per day, 44% were sedentary, 8.4% had first degree relatives with an osteoporotic fracture, 15.6% had osteopenia and 86% had received glucocorticosteroids, 56.4% of them at high dose. The risk factors more prevalent in Chronic Obstructive Pulmonary Disease in comparison with the other groups as well as the prevalence of each of them are shown in Table 1.
| Risk factor | Total | COPD (n=65) | ILD (n=82) | Other (n=32) | COPD versus ILD | COPD versus Other | ||
| OR (CI) | p | OR (CI) | p | |||||
| Menopausse | 46 (66.6) | 14 (77.8) | 24 (82.7) | 8 (36.4) | 0.93 (0.71-1.2) | 0.426 | 2.16 (1.2-3.89) | 0.007 |
| Calcium intake | 41 (22.9) | 19 (29.2) | 17 (20.7) | 5 (12.2) | 1.23 (0.81-1.87) | 0.235 | 1.44 (0.71-2.9) | 0.213 |
| Low body mass index | 22 (12.3) | 8 (12.3) | 5 (6.1) | 9 (28.1) | 2.01 (0.69-5.88) | 0.153 | 0.44 (0.19-1.03) | 0.053 |
| Smoking | 102 (57) | 58 (89.2) | 38 (46.3) | 6 (18.8) | 1.92 (1.5-2.46) | 0.000 | 4.75 (2.3-9.83) | 0.000 |
| packages/year | 24.7(32.4) | 51.1 (37) | 12.1 (17) | 3.4 (8) | 0.000 | 0.000 | ||
| Alcoholism | 9 (5) | 5 (7.7) | 4 (4.9) | 0 | 1.57 (0.44-5.64) | 0.356 | – | 0.128 |
| Sedentarism | 79 (44.1) | 37 (56.9) | 34 (41.5) | 8 (25) | 1.37 (0.98-1.91) | 0.045 | 2.27 (1.2-4.3) | 0.003 |
| Previous fracture | 17 (9.5) | 7 (10.8) | 10 (12.2) | 0 | 0.88 (0.36-2.19) | 0.5 | – | 0.054 |
| Fracture in a relative | 15 (8.4) | 5 (7.7) | 5 (6.1) | 5 (5.6) | 1.26 (0.38-4.17) | 0.475 | 2.03 (0.63-6.51) | 0.195 |
| Osteopenia producing disease | 28 (15.6) | 9 (13.8) | 7 (8.5) | 12 (37.5) | 1.62 (0.64-4.12) | 0.220 | 0.37 (0.17-0.78) | 0.009 |
| Oral glucocorticosteroids | 154 (86) | 62 (95.4) | 75 (91.5) | 17 (53.1) | 1.04 (0.96-1.14) | 0.270 | 1.79 (1.29-2.49) | 0.000 |
| High dosis | 101 (56.4) | 29 (46.8) | 59 (78.7) | 13 (76.5) | 0.59 (0.44-0.80) | 0.000 | 0.61 (0.42-0.89) | 0.027 |
| Vitamina D (ng/ml) | 18.1 (12.3) | 16.2 (11.3) | 19.2 (11.3) | 19.4 (15.7) | 0.388 | 0.092 | ||
| Parathormone (pg/ml) | 66.7 (39.2) | 73.2 (48) | 59.8 (28) | 71.1 (40.2) | 0.060 | 0.521 |
The risk factors associated with osteoporosis in all the patients were a low body mass index, smoking and previous fracture. In the different groups of lung diseases, the risk factor associated with osteoporosis in the Chronic Obstructive Pulmonary Disease group as well as in the Interstitial Lung Disease group was the presence of a previous fracture, with an OR of 1.81 (1.44-2.28) and 3.31 (1.07-10.24), respectively. In the group of other diseases the risk factor associated to osteoporosis was the glucocorticosteroid treatment, with an OR of 1.95 (1.08-3.52), without differences related to the dose.
Conclusion: In our cohort, the risk factors for low bone mass, depending on the disease, were smoking and sedentarism in the Chronic Obstructive Pulmonary Disease group. In the same group there was a major prevalence of menopause and glucocorticosteroid treatment, in comparison to the other groups. But the prevalence of high glucocorticosteroid dose in this group was lower than in the others. The risk factors for osteoporosis in lung transplantation candidates were previous fractures, smoking and a low body mass index. In the Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease groups the factor with greater association to osteoporosis was the presence of previous fractures and in the other diseases group glucocorticosteroid treatment.
To cite this abstract in AMA style:
Farietta-Varela S, Barceló-Bru M, Rodriguez-Díez B, López-Corbeto M, Trallero-Araguás E, De Agustin De Oro JJ, Coras R, Sellas-Fernandez A. Evaluation of Osteoporosis Risk Factors in Lung Transplant Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-osteoporosis-risk-factors-in-lung-transplant-patients/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-osteoporosis-risk-factors-in-lung-transplant-patients/