scholarly journals Preoperative bone health assessment and optimization in spine surgery

2020 ◽  
Vol 49 (2) ◽  
pp. E2
Author(s):  
Paul A. Anderson ◽  
Aamir Kadri ◽  
Kristyn J. Hare ◽  
Neil Binkley
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Spine Surgery ◽  
Bone Health ◽  
Health Assessment ◽  
Height Loss ◽  
Who Criteria ◽  
History Of ◽  
The Mean ◽  
Historical Height Loss

OBJECTIVEThe purpose of this investigation was to characterize the bone health in preoperative spine surgery patients. This information will provide a framework to understand the needs and methods for providing bone health optimization in elective spine surgery patients.METHODSA retrospective study of 104 patients undergoing bone health optimization was performed. Patients were selected based on risk factors identified by the surgeon and suspected compromised bone health. Evaluation included history and examination, laboratory investigations, and bone mineral density (BMD) at 3 sites (femoral neck, lumbar spine, and radius). Patients’ bone status was classified using WHO criteria and expanded criteria recommended by the National Osteoporosis Foundation (NOF). The 10-year Fracture Risk Assessment Tool (FRAX) scores of the hip and major osteoporotic fracture (MOF) were calculated with and without femoral neck BMD, with spine BMD, and with the trabecular bone score (TBS). Antiresorptive and anabolic agents were provided in accordance with meeting NOF criteria for treatment of osteoporosis.RESULTSThe mean patient age was 69.0 years, and 81% of patients were female. The mean historical height loss was 5.6 cm, and 54% of patients had a history of fracture. Secondary osteoporosis due to chronic renal failure, inflammatory arthritis, diabetes, and steroid use was common (51%). The mean 25-hydroxy vitamin D was 42.4 ng/ml and was normal in 81% of patients, with only 4 patients being deficient. The mean T-scores were −2.09 (SD 0.71) of the femoral neck, −0.54 (1.71) of the lumbar spine, and −1.65 (1.38) of the distal radius. These were significantly different. The 10-year FRAX MOF score was 20.7%, and that for hip fracture was 6.9% using the femoral neck BMD and was not significantly different without the use of BMD. The FRAX risk-adjusted score using the lumbar spine BMD and TBS was significantly lower than that for the hip. Osteoporosis was present in 32.1% according to WHO criteria compared with 81.6% according to NOF criteria. Antiresorptive medications were recommended in 31 patients and anabolic medications in 44 patients.CONCLUSIONSSurgeons can reliably identify patients with poor bone health by using simple criteria, including historical height loss, history of fracture, comorbidities associated with osteoporosis, analysis of available imaging, and calculation of FRAX score without BMD. High-risk patients should have BMD testing and bone health assessment. In patients with osteoporosis, a comprehensive preoperative bone health assessment is recommended and, if warranted, pharmacological treatment should be started.

scholarly journals Osteoporosis in spine surgery patients: what is the best way to diagnose osteoporosis in this population?

2020 ◽  
Vol 49 (2) ◽  
pp. E4 ◽  
Author(s):  
Jeffery D. St. Jeor ◽  
Taylor J. Jackson ◽  
Ashley E. Xiong ◽  
Aamir Kadri ◽  
Brett A. Freedman ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Spine Surgery ◽  
Bone Health ◽  
Assessment Tools ◽  
Lumbar Spine Surgery ◽  
Total Hip ◽  
T Score ◽  
Preoperative Optimization ◽  
The Mean

OBJECTIVEThe goal of this study was to compare different recognized definitions of osteoporosis in patients with degenerative lumbar spine pathology undergoing elective spinal fusion surgery to determine which patient population should be considered for preoperative optimization.METHODSA retrospective review of patients in whom lumbar spine surgery was planned at 2 academic medical centers was performed, and the rate of osteoporosis was compared based on different recognized definitions. Assessments were made based on dual-energy x-ray absorptiometry (DXA), CT Hounsfield units (HU), trabecular bone score (TBS), and fracture risk assessment tool (FRAX). The rate of osteoporosis was compared based on different definitions: 1) the WHO definition (T-score ≤ −2.5) at total hip or spine; 2) CT HU of < 110; 3) National Bone Health Alliance (NBHA) guidelines; and 4) “expanded spine” criteria, which includes patients meeting NBHA criteria and/or HU < 110, and/or “degraded” TBS in the setting of an osteopenic T-score. Inclusion criteria were adult patients with a DXA scan of the total hip and/or spine performed within 1 year and a lumbar spine CT scan within 6 months of the physician visit.RESULTSTwo hundred forty-four patients were included. The mean age was 68.3 years, with 70.5% female, 96.7% Caucasian, and the mean BMI was 28.8. Fracture history was reported in 53.8% of patients. The proportion of patients identified with osteoporosis on DXA, HUs, NBHA guidelines, and the authors’ proposed “expanded spine” criteria was 25.4%, 36.5%, 75%, and 81.9%, respectively. Of the patients not identified with osteoporosis on DXA, 31.3% had osteoporosis based on HU, 55.1% had osteoporosis with NBHA, and 70.4% had osteoporosis with expanded spine criteria (p < 0.05), with poor correlations among the different assessment tools.CONCLUSIONSLimitations in the use of DXA T-scores alone to diagnose osteoporosis in patients with lumbar spondylosis has prompted interest in additional methods of evaluating bone health in the spine, such as CT HU, TBS, and FRAX, to inform guidelines that aim to reduce fracture risk. However, no current osteoporosis assessment was developed with a focus on improving outcomes in spinal surgery. Therefore, the authors propose an expanded spine definition for osteoporosis to identify a more comprehensive cohort of patients with potential poor bone health who could be considered for preoperative optimization, although further study is needed to validate these results in terms of clinical outcomes.

scholarly journals An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

2017 ◽  
Vol 27 (4) ◽  
pp. 357-369 ◽  
Author(s):  
Matthew J. McGirt ◽  
Mohamad Bydon ◽  
Kristin R. Archer ◽  
Clinton J. Devin ◽  
Silky Chotai ◽  
...  
Keyword(s):  
Decision Making ◽  
Lumbar Spine ◽  
Predictive Model ◽  
Spine Surgery ◽  
Smoking Status ◽  
Lumbar Spine Surgery ◽  
Symptom Duration ◽  
Quality Outcomes ◽  
Pain Outcomes ◽  
History Of

OBJECTIVEQuality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery.METHODSIncluded in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers’ compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO.RESULTSThere was a significant improvement in all PROs (p < 0.0001) at 12 months following lumbar spine surgery. The most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers’ compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes).CONCLUSIONSThis study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.

Estimation of Central Osteopenia in Children With Chronic Polyarthritis Treated With Glucocorticoids

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1127-1130
Author(s):  
Antero Kotaniemi ◽  
Anneli Savolainen ◽  
Hannu Kautiainen ◽  
Heikki Kröger
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Bone Size ◽  
Mineral Density ◽  
Volumetric Density ◽  
Chronic Polyarthritis ◽  
The Mean ◽  
Bone Volumetric Density

Study objective. To investigate the degree and determinants of osteopenia in juvenile chronic polyarthritis. Design. Retrospective case-control study of central bone mineral density. Setting. Rheumatism Foundation Hospital and Kuopio University Hospital, Finland. Subjects. A sample of 43 girls aged 7 to 19 with juvenile chronic polyarthritis treated with systemic glucocorticoids and a control sample of 44 healthy girls matched for age. Main outcome measures. Bone mineral density and bone size (width) measured by dual-energy x-ray absorptiometry and bone volumetric density calculated as an approximation of true bone density at both the lumbar spine and femoral neck. Results. The girls with juvenile chronic arthritis had reduced bone mineral density, bone size, and bone volumetric density at both the lumbar spine and femoral neck (statistically significant findings, P = .022 for the bone size of the femoral neck and P &lt; .001 for the other parameters). At the spine, the mean bone mineral density was 80%, the mean bone size 89%, and the mean bone volumetric density 89% of the values in the control group. At the femoral neck, the values were 78%, 93%, and 83%, respectively. The groups were matched for age, but the girls with arthritis were smaller and lighter. In the juvenile arthritis group, the femoral bone mineral density and bone volumetric density and the spinal bone width correlated negatively with the mean glucocorticoid dose. Conclusion. Axial bone mineral density is clearly reduced in severe juvenile polyarthritis and is mediated by both decreased bone volumetric density and diminished growth.

scholarly journals BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

2016 ◽  
Vol 17 (2) ◽  
pp. 138-141
Author(s):  
Samira Sharmin ◽  
Mabubul Haque ◽  
Syedur Rahman Miah ◽  
Md Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Postmenopausal Women ◽  
Lumbar Vertebrae ◽  
The Body ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score ◽  
Minimal Trauma ◽  
The Mean

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearson’s correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

scholarly journals Risk factors for deep surgical site infection following thoracolumbar spinal surgery

2020 ◽  
Vol 32 (2) ◽  
pp. 292-301 ◽  
Author(s):  
Hansen Deng ◽  
Andrew K. Chan ◽  
Simon G. Ammanuel ◽  
Alvin Y. Chan ◽  
Taemin Oh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Thoracolumbar Spine ◽  
Hospital Length Of Stay ◽  
Site Infection ◽  
Asa Classification ◽  
Estimated Blood Loss ◽  
History Of ◽  
The Mean

OBJECTIVESurgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.METHODSAll patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.RESULTSIn total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p < 0.001), were more likely to have an ASA classification > II (48.0% vs 36.0%, p < 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p < 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.CONCLUSIONSThis institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.

scholarly journals TO DETERMINE THE PREVALENCE OF LOW BONE MINERAL DENSITY (OSTEOPENIA AND OSTEOPOROSIS) IN INDIAN PATIENTS WITH CIRRHOSIS OF LIVER AWAITING LIVER TRANSPLANTATION AS PER CURRENTLY USED HOLOGIC DXA DATABASE

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Sharad Deshmukh ◽  
Suchita Deshmukh ◽  
Sarojni A Parameswran ◽  
P Pirmanayagam ◽  
N Murgan ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Liver Transplantation ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Indian Patients ◽  
History Of ◽  
The Mean ◽  
Cirrhosis Of Liver

Background: Abnormalities in the bone metabolism observed in chronic liver disease are referred to as hepatic osteodystrophy. Osteoporosis and osteopenia are each part of this condition. Both conditions have a significant impact on morbidity, causing fractures that may result in chronic pain, long-lasting immobility, and deformity. Prevalence of fracture in patients with liver transplantation ranges from 15% - 65%. A high rate of fracturing is seen within the initial 1–2 years after transplantation. Aim: To determine the prevalence of low bone mineral density (osteopenia and osteoporosis) in Indian patients with cirrhosis of liver awaiting liver transplantation as per currently used Hologic DXA database Methods: This was a prospective observational study done at the department of gastroenterology and hepatology, Apollo Hospitals, Chennai from April 2011 to March 2013. All patients who fulfilled the inclusion criteria underwent detailed history taking, physical examination and relevant laboratory investigations. One hundred patients were selected for the scope of the study. Results: Sixty-eight per cent of patients were in the age group of 45 to 65 years. The mean age ± SD of the study subjects was 51.2 ± 9.7 years. The mean age for male patients was 50.5 ± 10.1 years, and for females was 54 ± 7.3 years. Cirrhosis was due to alcohol in 36% of the patients, viral hepatitis in 28% (HBV in 10% and HCV in 18%) patients. 42% were in Child’s class B, and the remaining 58% were in Child’s class C. MELD score was less than 20 in 62% patients. One third was diabetic; one third gave the history of backache. History of smoking was present in one fifth (20%) patients, and a history of fracture (most of them were traumatic) was present in 13% of patients. By using Hologic DXA database at the lumbar spine, osteopenia and osteoporosis were diagnosed in 44% and 38 % patients respectively. At the femoral neck, osteopenia and osteoporosis were diagnosed in 45% and 9% of patients. By using ICMR database at the lumbar spine, osteopenia and osteoporosis were diagnosed in 38% and 17% patients respectively. Similarly, at the femoral neck, osteopenia and osteoporosis were diagnosed in 34% and 5%. By using the Hologic DXA database, osteopenia and osteoporosis were diagnosed in 42% and 40 % patients. By using ICMR database, osteopenia and osteoporosis were diagnosed in 43% and 19% patients respectively. Conclusion: In light of the above results, the present study revealed a high prevalence of low bone mineral density (osteopenia and osteoporosis) in Indian patients with cirrhosis of liver awaiting liver transplantation. The lumbar spine was the most frequently and severely affected site in hepatic osteodystrophy. Keywords: Osteopenia, Osteoporosis, Low Bone Mineral Density, Liver Cirrhosis

scholarly journals Variations in 30-day readmissions and length of stay among spine surgeons: a national study of elective spine surgery among US Medicare beneficiaries

2018 ◽  
Vol 29 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Siddhartha Singh ◽  
Rodney Sparapani ◽  
Marjorie C. Wang
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Practice Patterns ◽  
Lumbar Spine Surgery ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Underlying Assumption ◽  
The Mean ◽  
Hospital Characteristics

OBJECTIVEPay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions.METHODSThe authors applied validated ICD-9-CM algorithms to 2003–2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models.RESULTSA total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size.CONCLUSIONSThe authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.

scholarly journals The therapeutic efficacy of denosumab for the loss of bone mineral density in glucocorticoid-induced osteoporosis: a meta-analysis

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Yuta Yamaguchi ◽  
Takayoshi Morita ◽  
Atsushi Kumanogoh
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Meta Analysis ◽  
Bisphosphonate Therapy ◽  
Rate Of Change ◽  
Response To Treatment ◽  
Mineral Density ◽  
Total Hip ◽  
The Mean ◽  
The Impact

Abstract Objective Prevention of steroidal osteoporosis is an important issue. There is no clear consensus on the impact of anti-RANKL antibody (denosumab) on BMD in patients with glucocorticoid-induced osteoporosis (GIO). In this study, we aimed to evaluate the impact of denosumab on BMD loss in patients with GIO. Methods A comprehensive systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science and Google Scholar were used to search for original studies reported about BMD in patients with GIO treated with denosumab. In meta-analysis of BMD, the mean difference in the rate of change from baseline and the 95% CI were calculated using the random effects model. The mean differences in patients treated with denosumab were compared with those in patients treated with bisphosphonates. Results Out of 713 studies identified, seven studies met the selection criteria for the meta-analysis. At 6 and 12 months of denosumab therapy, increases in BMD were observed in the lumbar spine (2.99% [95% CI 2.71, 3.28] and 4.59% [95% CI 4.17, 5.01]), total hip (1.34% [95% CI 0.64, 2.04] and 2.16% [95% CI 2.05, 2.27]) and femoral neck (0.12% [95% CI −0.38, 0.62] and 1.55% [95% CI 0.45, 2.65]). Additionally, denosumab resulted in significant increases in BMD in the lumbar spine and femoral neck at 12 months compared with bisphosphonate therapy. Conclusion Patients with GIO experienced significant increases in BMD in response to treatment with denosumab that were detected in the lumbar spine, total hip and femoral neck at 12 months.

scholarly journals Evaluation of bone disease in patients with cystic fibrosis and end-stage lung disease

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Cécile A. Robinson ◽  
Markus Hofer ◽  
Christian Benden ◽  
Christoph Schmid
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Lung Disease ◽  
Bone Disease ◽  
Biochemical Markers ◽  
Skeletal Site ◽  
The Mean ◽  
End Stage

ABSTRACT Objective: Bone disease is a common comorbidity in patients with cystic fibrosis (CF). We sought to determine risk factors and identify potential biochemical markers for CF-related bone disease (CFBD) in a unique cohort of CF patients with end-stage lung disease undergoing lung transplantation (LTx) evaluation. Methods: All of the CF patients who were evaluated for LTx at our center between November of 1992 and December of 2010 were included in the study. Clinical data and biochemical markers of bone turnover, as well as bone mineral density (BMD) at the lumbar spine and femoral neck, were evaluated. Spearman’s rho and multivariate logistic regression analysis were used. Results: A total of 102 adult CF patients were evaluated. The mean age was 28.1 years (95% CI: 26.7-29.5), and the mean body mass index was 17.5 kg/m2 (95% CI: 17.2-18.2). Mean T-scores were −2.3 and −1.9 at the lumbar spine and femoral neck, respectively, being lower in males than in females (−2.7 vs. −2.0 at the lumbar spine and −2.2 vs. −1.7 at the femoral neck). Overall, 52% had a T-score of < −2.5 at either skeletal site. The homozygous Phe508del genotype was found in 57% of patients without osteoporosis and in 60% of those with low BMD. Mean T-scores were not particularly low in patients with severe CFTR mutations. Although the BMI correlated with T-scores at the femoral neck and lumbar spine, serum 25-hydroxyvitamin D and parathyroid hormone levels did not. Conclusions: CFBD is common in CF patients with end-stage lung disease, particularly in males and patients with a low BMI. It appears that CF mutation status does not correlate with CFBD. In addition, it appears that low BMD does not correlate with other risk factors or biochemical parameters. The prevalence of CFBD appears to have recently decreased, most likely reflecting increased efforts at earlier diagnosis and treatment.

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