Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study.

Carla Caffarelli,Stefano Gonnelli,Antonella Fossi,Sonia Bernazzali,Paolo Cameli,David Bennett,Maria D Tomai Pitinca,Mario Alessandri,Elena Bargagli

doi:10.3390/jcm9092941

Abstract

Bone loss and bone fractures are common complications after organ transplantation. Many factors contribute to the pathogenesis of transplant osteoporosis, such as bone disease preceding transplantation, immunosuppressive medications, and nutritional and lifestyle factors. This study aimed to assess the incidence of vertebral fractures before and after lung and heart transplantation. This longitudinal study analyzed 213 electronic medical records of patients who underwent lung transplantation (n = 128) and heart transplantation (n = 85) at Siena University Medical Center between January 2000 and December 2018. In lung and heart transplant recipients, the bone mineral density in the femoral sub-regions show a significant decrease at post-transplantation and at follow up visits. In both lung and heart recipients, we found an increase in the fracture incidence in the first period after transplantation (19.5% vs. 50.4% in lung recipients; 9.6% vs. 25.7% in heart recipients). Moreover, in lung recipients, vertebral fractures were predicted primarily by age, BMD at the femur, and any history of fracture. In heart recipients, vertebral fractures were predicted only by history of fracture. Our study supports the recommendations for pre-transplant osteoporosis screening in patients undergoing lung transplants, and in the first period after transplantation in heart transplant recipients.

Highlights

Organ transplantation has become an established therapy for many end-stage diseases, including acute and chronic liver failure, end-stage renal disease, end-stage pulmonary disease, and heart failure [1,2]
This study confirms that lung transplant patients present with greater bone loss and higher fracture risk before lung transplantation, with respect to heart transplant recipients [4,19]
Almost one fifth of the subjects had a vertebral fracture before lung transplantation, while less than 10% of heart patients had a history of vertebral fractures

Summary

Introduction

Organ transplantation has become an established therapy for many end-stage diseases, including acute and chronic liver failure, end-stage renal disease, end-stage pulmonary disease, and heart failure [1,2]. The number of successful organs transplanted has increased, as well as the survival of the transplant recipients. Osteoporosis and fragility fractures are among the complications that have become more prevalent with the increased survival of patients after solid organ transplantation. The prevalence of osteoporosis among candidates expecting various organ transplantations is high; in particular, in subjects awaiting lung transplant, osteoporosis was estimated to range from 35% to 61% [4,5]. Vertebral fractures are the most common type of osteoporotic fracture and have important consequences, including increased risk for subsequent fracture and reduced quality of life [7]. In this particular group of patients, increased spine fracture burden was associated with an increaseJ.iCnlinb.

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Conclusion