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

TL;DR

Lung transplant recipients face increased risk of osteoporotic fractures, but protocolized treatment with zoledronic acid helps reduce this risk.

Contribution

Identifies predictors of osteoporotic fractures in lung transplant recipients and evaluates the effectiveness of protocolized antiresorptive therapy.

Findings

Osteoporotic fracture prevalence increased from 12% pre-LT to 15% post-LT.

Female sex, prior fractures, and delayed zoledronic acid treatment were significant risk factors.

Protocolized antiresorptive therapy was associated with a low incidence of osteoporotic fractures.

Abstract

As life expectancy following lung transplantation (LT) improves, vulnerability to glucocorticoid-induced osteoporotic fractures is increased. Our institution offers LT recipients protocolized antiresorptive 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. Coprimary outcomes were incidence, prevalence, and predictors of osteoporotic fractures and major osteoporotic fractures post-LT.

Four hundred and five LT recipients (41% female, median age 59 years) had a median follow-up of 4.9 years (interquartile range 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 antiresorptive treatment post-LT had a low incidence of osteoporotic fracture.

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