Background/Purpose: Osteoporosis is a very frequent complication in recipients of a lung transplant . The factors that intervene can be previous to the transplant, such as the individual risk, the underlying disease, the treatments received but also the ones related to the lung transplant, like the prolonged post-surgery immobilization. The rate of bone mass loss in the lumbar spine and the femoral neck in the first year is around 2-5% and fracture prevalence is between 18-37%. The objectives of this study were to evaluate the effect of antiresorptive, glucocorticosteroids and other immunosuppressive treatments on bone mineral density in lung transplant patients.

Methods: This is a retrospective study on a cohort of 179 patients who were submitted to lung transplant between 2004 and 2014 in the Vall d’Hebron University Hospital. A bone densitometry was practiced to all patients before and after the lung transplant. The comparison between the determinations was made by calculating the percentage of change in bone mass expressed in g/cm² at each of the explored region: the lumbar spine (L2-L4), the femoral neck and the total femur. For the analysis of the effect of immunosuppressant therapy on bone mineral mass, a subgroup of 136 patients was selected, who were receiving a standard treatment regimen: glucocorticosteroids, tacrolimus and mycophenolate. 3 groups were established, depending on the moment of the densitometry realization: in the first 6 months, between 6 and 12 months and more than 12 months after the lung transplant. The correlation between bone mineral loss in the regions of interest and the accumulated dose of each of the treatments was evaluated using logistic regression and multivariate analysis.

Results: Out of the 179 patients, 121 received treatment for osteoporosis after the lung transplant (89 were previously receiving it). Table 1 shows the number of treated patients as well as the received treatments. The average time (rank) between the start of the treatment and the realization of the bone densitometry post-transplant was of 24 months (5-120).

Among the 136 patients (58.8% men) who were selected for the study of the effect of immunosuppressants on bone mineral mass, 49 (36%) had been diagnosed of Chronic Obstructive Pulmonary Disease, 64 (47%) of Interstitial Lung Disease and 23 (17%) of other pulmonary diseases. The average percentage of variation of the bone mineral mass in all 136 patients was of +1.3% in lumbar spine, -3.4% in femoral neck and -2.3% in total femur. The percentage of variation of bone mineral mass pre and post-transplant in the treated patients was of 2.8% for the lumbar spine, -0.5% for the femoral neck and -1.3% for the total femur, in comparison to the group of untreated patients where the variation was of -2.5, -5.4% and -3.9, respectively. There was no significant difference in the average accumulated dose of glucocorticosteroids and immunosuppressants between patients whose post-transplant bone mineral mass improved or worsened, in none of the studied regions, nor in the global study or in either of the subgroups of studied diseases. In the multivariate analysis, feminine sex was the only variable which was associated to bone mineral loss in all the studied regions, except for the femoral neck.

Conclusion: The patients who received antiresorptive treatment pre transplant have a major increment of bone mineral mass at the lumbar spine and a lower post-transplant bone mineral mass loss than the not treated ones. No association was observed between glucocorticosteroid and other immunosuppressants and post-transplant bone mineral mass.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-immunosuppressive-and-antiresorptive-therapy-on-bone-mineral-density-in-lung-transplant-patients/