Background/Purpose: Osteoporosis prevalence in lung transplantation candidates is between 16-21%. In the last years, the survival rate after lung transplantation has definitely improved, due to the improvement of the surgical techniques, of the treatment in the intensive care unit and the development of better immunosuppressive therapy. In spite of this, it was observed that there is a rapid loss of bone mass in these patients in the first year post-transplantation, probably due to prolonged immobilization post-surgery, to high doses of glucocorticosteroids used to prevent acute rejection and to the immunosuppressive regimen. Prospective studies have been conducted which demonstrated changes in bone mass and a major incidence of fractures in lung transplant patients. Our objectives were to determine the prevalence of osteopenia, osteoporosis and fractures in lung transplantation candidates and lung transplant patients in a reference center as well as to evaluate the change of bone mass pre and post transplantation.

Methods: We included 179 patients from the cohort of lung transplant patients of Vall d’Hebron University Hospital, whose femoral and lumbar bone mineral density determinations pre and post-transplant were available. Since it is a retrospective study and the moment of the post-transplant bone densitometry couldn’t be standardized, the patients were stratified depending on the moment of the realization of the densitometry: less than 6 months, between 7 and 12 months and more than 12 months after the transplant.

Results: Out of the 179 patients, 110 were men and 69 were women, and their average age was 51±10.4 years. The prevalence of pre and post-transplant osteoporosis, osteopenia and symptomatic fractures is shown in table 1.

No significant differences were observed when comparing the percentage of men and women with osteoporosis and osteopenia before and after the transplant, in relation to the patients’ sex or age. The change of bone mass post-transplant, expressed in gr/cm² was of 1.3% (±15.3) in the lumbar spine, -2.1 (±11.3) in the femoral neck and 2.1(±9) in the total femur. The patients’ diagnostic change after lung transplant is shown in table 2.

More than 60% of the patients didn’t have a diagnostic change after the transplant. Out of the 11 patients with normal pre transplant bone densitometry and post-transplant osteopenia, 9 had previously received osteoporosis treatment. Out of the patients with pre transplant osteopenia, 16 had osteoporosis afterwards, 8 of whom had not received previous treatment. 14 patients that had pre transplant osteoporosis improved to osteopenia post-transplant, out of which 12 had been previously treated.

Conclusion:  In our series the prevalence of osteoporosis and osteopenia was of 38% and 45.8%, respectively. The prevalence of pre-transplant symptomatic fractures was of 9.5%. The prevalence of post-transplant osteoporosis and osteopenia was of 38.5% and 48.6%, respectively. The prevalence of post-transplant symptomatic fractures was of 11.2%. In our cohort, the majority of patients whose bone densitometry worsened from normal/osteopenia to osteoporosis had not received pre transplant prophylactic treatment. The post-transplant bone mass loss was between 1-2%, and the most affected regions were the total femur and the femoral neck.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-prevalence-in-lung-transplant-patients/