Incidence, prevalence, and predictors of osteoporotic fracture in adult lung transplant recipients

Abstract

As life expectancy following lung transplantation (LT) improves, vulnerability to glucocorticoid-induced osteoporotic fractures is increased. Our institution offers LT recipients protocolized anti-resorptive therapy, with zoledronic acid (ZA) used first line. Adults who underwent LT from January 2012 to December 2018 and survived at least 6 months were retrospectively studied. Co-primary outcomes were incidence, prevalence and predictors of osteoporotic fractures and major osteoporotic fractures post-LT. 405 LT recipients (41% female, median age 59 years) had median follow up of 4.9 years (Interquartile range (IQR) 3.4-6.7). Osteoporotic fracture prevalence was 12% (n=49) pre-LT and 15% (n=60) post-LT. Major osteoporotic fracture post-LT occurred in 11% (n=45). Antiresorptive therapy was received by 47% pre- and 89% post-LT. On multivariate analysis, risk factors for osteoporotic fracture were pre-LT osteoporotic fracture (Hazard ratio (HR) 2.32 (95% confidence interval (CI) 1.09-4.96)), female sex (HR 2.08 (95% CI 1.09-3.94)), glucocorticoid use pre-LT (HR 2.08 (95% CI 1.09-3.99)), and time (months) to first ZA infusion post-LT (HR 1.04 (95% CI 1.01-1.06)). Risk factors for major osteoporotic fracture were pre-LT osteoporotic fracture, female sex, age and time to first ZA infusion. LT recipients receiving protocolized anti-resorptive treatment post-LT had a low incidence of osteoporotic fracture. Data availability statementEthics approval for this project does not extend to sharing of data for this study. Specific data requests should be made to the corresponding author.