Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun:111:129-134.
doi: 10.1016/j.bone.2018.03.021. Epub 2018 Mar 27.

Low bone density and fractures before and after pediatric lung transplantation

Melissa S Putman  1 , Tregony Simoneau  2 , Henry A Feldman  3 , Alexandra Haagensen  4 , Debra Boyer  5
Affiliations

Low bone density and fractures before and after pediatric lung transplantation

Melissa S Putman et al. Bone. 2018 Jun.

Abstract

Introduction: Children undergoing lung transplant are at risk for low bone mineral density (BMD) and fractures. The effect of lung transplantation on bone health in pediatric patients is unknown.

Materials and methods: We performed a retrospective chart review of all patients ages 2-21 years who underwent lung transplantation at our hospital from January 2000 to January 2015.

Results: 51 patients were studied. At the time of transplant evaluation, BMD Z-score was -2.2 ± 1.4, and 59% of patients had low BMD. BMD Z-score declined in the first year after treatment and returned to near-baseline by the third post-transplant year. Fractures occurred in 9 patients (18%) before and 15 patients (29%) after transplant. Bisphosphonate use was associated with improvement in BMD Z-score and lower mortality risk.

Conclusions: Pediatric patients had a high prevalence of low BMD at the time of lung transplant evaluation. BMD Z-scores declined in the year after transplant and returned to the pre-transplant level by the third post-transplant year while remaining below normal levels. Fractures were common at sites associated with significant morbidity. These findings support efforts to optimize bone health before and after pediatric lung transplantation, and future studies are needed to evaluate the role of bisphosphonates in these patients.

Keywords: Bisphosphonate; Bone mineral density; Fracture; Lung transplantation; Pediatric.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of Interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Changes in absolute BMD at the spine and hip after lung transplantation.
Figure 2
Figure 2
Changes in BMD Z-score at the spine and hip after lung transplantation. Unadjusted results are presented in panel 2a. Multivariable adjusted results after adjustment for 25(OH)D, height Z-score, and number of rejection episodes are presented in panel 2b.
See this image and copyright information in PMC

References

    1. Shane E, Silverberg SJ, Donovan D, Papadopoulos A, Staron RB, Addesso V, et al. Osteoporosis in lung transplantation candidates with end-stage pulmonary disease. Am J Med. 1996;101(3):262–9. - PubMed
    1. Maalouf NM, Shane E. Osteoporosis after solid organ transplantation. J Clin Endocrinol Metab. 2005;90(4):2456–65. - PubMed
    1. Spira A, Gutierrez C, Chaparro C, Hutcheon MA, Chan CK. Osteoporosis and lung transplantation: a prospective study. Chest. 2000;117(2):476–81. - PubMed
    1. Shane E, Rivas M, McMahon DJ, Staron RB, Silverberg SJ, Seibel MJ, et al. Bone loss and turnover after cardiac transplantation. J Clin Endocrinol Metab. 1997;82(5):1497–506. - PubMed
    1. Stein E, Ebeling P, Shane E. Post-transplantation osteoporosis. Endocrinology and metabolism clinics of North America. 2007;36(4):937–63. viii. - PubMed

Publication types