Background
Cystic fibrosis (CF) is associated with reduced bone mineral density and increased risk of fragility fractures. Adults with end-stage CF lung disease requiring lung transplantation (LT) would be expected to be at highest risk of osteoporotic fractures. Our institution implemented a protocol for zoledronic acid (ZA) infusion for all adults waitlisted for LT to prevent anticipated bone loss. The objective of this study was to compare fracture prevalence in adults with CF to those with non-CF aetiologies post-LT.
Methods
This was a single centre retrospective study of all adults who received LT at Alfred Health, Australia between January 2012 to December 2018 to evaluate prevalence of osteoporotic fracture. Data was retrieved from electronic medical records. LT recipients were divided into two groups based on CF status and compared using statistical methods with p-value <0.05 deemed significant.
Results
In total, 405 LT recipients were included in our audit, of whom 58 (14.3%) had CF. Of these adults with CF, 51.7% (30/58) were female and this was comparable to the non-CF group (p-value 0.09). In the non-CF group, 18% (n=63/347) osteoporotic fractures whilst no osteoporotic fractures occurred in our CF group post LT. Compared to non-CF aetiologies, adults with CF were significantly younger in age 34.2 ± 10.2 vs 58.8 ± 9.93 (p-value <0.0001). We also found no significant differences in pre- or post LT ZA infusion rates between the two groups.
Discussion
We found adults with CF experienced no osteoporotic fractures post-LT. We postulate our results may be attributed to young age, protocol-driven ZA with cumulative benefits from improved nutrition, aggressive vitamin D replacement and reduced inflammation due to enhanced anti-microbial management in adults with CF.