Severe osteoporosis before and after lung transplantation

Study objective: Osteoporosis and/or fractures have been reported as a complication of kidney, heart, liver, bane marrow, and, most recently, lung transplantation (LTx). We measured bone mineral density (BMD) before and after LTx to determine the frequency and severity of preoperative and postoperative osteoporosis. Patients and methods: We conducted a cross-sectional study of BMD in 100 patients with various diagnoses before (n=55) and after (n=45) LTx. Results: Age-matched mean spine and femoral BMDs were severely depressed before and after LTx placing 45% of the pre-LTx and 73% of the post-LTx patients at or below the fracture threshold (2 SDs below the mean). As expected, patients with cystic fibrosis had lower (p<0.05) mean spine and femoral BMD than patients with COPD or other lung diseases both before and after LTx. Nevertheless, considerable osteoporosis was present in the patients with COPD and other lung diseases before and after LTx. The best predictors of pre- and post-LTx Z scores were body mass index: (r=0.56 to 0.59, p<0.001) and cumulative steroid dose/per kilogram (r=0.49-0.51, p<0.001), respectively. Osteoporosis has resulted in 3 symptomatic fractures before and 12 after LTx. Conclusions: Osteoporosis appears to be widespread in patients with end-stage respiratory failure before LTx and LTx, while often life-saving, has an adverse impact on BMD. As patients live longer after LTx, osteoporosis-related fractures may compromise quality of life by causing pain and debilitation.