Poster Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Incidence and prevalence of osteoporotic fracture in adult lung transplant recipients: a single centre audit (#230)

Shanal Kumar 1 , Eldho Paul 1 , Elisabeth Ng 2 , Daniel Bennett 3 , Luisa Rosi 3 , Lauren Chiu 3 , Kathryn Hackman 2
  1. Monash Centre for Health Research and Implementation, Monash University, Clayton
  2. Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia , Melbourne
  3. Department of Medicine, Monash University, Melbourne

Background

As life expectancy in lung transplant (LT) recipients improves, there is increasing vulnerability to morbidity associated with long-term, high-dose glucocorticoid immunosuppression, including osteoporotic fractures. For LT recipients at our institution, protocolised intravenous zoledronic acid infusion to minimise glucocorticoid-induced osteoporosis and fracture is offered. The objective of this study was to determine the incidence and prevalence of osteoporotic fracture and treatment-associated adverse events in our contemporary cohort.

 Methods

We conducted a retrospective study of all adults who underwent LT from January 2012 to December 2018 and survived at least 6 months. Data relating to demographics, fractures and anti-resorptive therapies were obtained from electronic medical records. Primary outcomes were incidence and prevalence of osteoporotic fractures post-LT. Secondary outcomes included treatment-related adverse events.

Results

In total, 405 LT recipients (41% female, median age 59 years) were included, with a median follow up of 4.9 years (IQR 3.4-6.7). The cumulative incidence of osteoporotic fracture was 3.2%, 11.6% and 14.6%  at 1, 3 and 5 years respectively. The prevalence of osteoporotic fractures in our study cohort was 21% (n = 86), with pre-LT osteoporotic fracture occurring in 9% (n=37) and post-LT osteoporotic fracture in 16% (n=63) of individuals. The median time to first osteoporotic fracture post-LT was 1.6 years (IQR 1.1 – 3.0 years). The most common major osteoporotic fracture site was the vertebrae. Anti-resorptive therapy was received by 47% pre- and 89% post-LT with treatment-related events uncommon. Two individuals sustained atypical femoral fractures during the study period.

Discussion

We found the incidence and prevalence of osteoporotic fracture post-LT  in our cohort was lower compared to historical cohorts and in keeping with recently published contemporary cohorts. Protocol driven intravenous zoledronic acid infusions appear well tolerated in adults with end-stage lung disease and may prevent bone loss and associated fracture.