Incidence of Fractures after Cardiac and Lung Transplantation: A Single Center Experience

Abstract

Osteoporotic fractures are well-known complications of organ transplantation. Fracture rates up to 35% have been previously reported following heart and lung transplantations. Our institutional pretransplant protocols include DXA scans, vitamin D screening, and appropriate antiresorptive therapy. We aimed to assess the incidence of fragility fractures following cardiac or lung transplantation. In a retrospective study 210 electronic medical records of patients who underwent LT (110 men, 100 women) and 105 HT (88 men, 17 women) between 2005 and 2010 were analyzed. Both clinical and radiographic fractures were recorded. DXA scans were obtained immediately after transplant. 17 out of 210 LT patients (8.0%) had fractures after transplantation and 9 out of 105 HT patients (8.6%) had fractures. The median time to the first fracture was 12 months and the mean time was 18 months for both LT and HT. In the HT recipients, the median femoral neck T score was statistically lower in the fracture group versus the nonfracture group. Similar results were seen in the LT patients. Conclusion. Our findings demonstrate a much lower incidence of fractures in heart and lung transplant recipients in comparison with earlier reports. Comprehensive bone care and early initiation of antiresorptive therapy are possible contributors to these improved outcomes.

Timing of Osteoporotic Vertebral Fractures in Lung and Heart Transplantation: A Longitudinal Study

“…This study, carried out on a large cohort of cardiac and lung transplant patients, shows that the presence and, above all, the burden of vertebral fractures are greater in the first period after transplantation. Our results are in agreement with previous studies reporting that patients with lung and heart diseases present with bone loss and increased risk of vertebral fracture within the first months after transplantation [ 13 , 14 , 15 , 16 , 17 ]. The causes of bone loss and fragility fractures in transplant patients are numerous.…”

“…However, according to previous studies, vertebral fractures occur in the first period after transplantation, and may affect patients with either low or normal pre-transplant BMD [ 14 ]. A small number of prospective studies have evaluated the prevalence and incidence of vertebral fractures after lung transplantation [ 4 , 16 , 17 , 24 , 25 , 26 , 27 ]. All of these studies had limitations related to their relatively small sample sizes, and differences between studies may also result from the variety of underlying lung diseases and differences in the severity of these.…”

Current Status of Research on Osteoporosis after Solid Organ Transplantation: Pathogenesis and Management

“…In a very recent research, Hariman et al retrospectively analyzed 210 medical records of patients receiving lung transplantation and found 17 patients (8.0%) had fractures after transplantation. The incidence of fracture in lung transplant patients in years 1 to 5 was 4.8%, 1.0%, 0.0%, 1.0%, and 1.9%, respectively [ 95 ], probably owning to the early initiation of antiresorptive therapy. Another study conducted by Cahill et al showed that antiresorptive therapy with pamidronate preserved or increased BMD prior to and following transplantation, resulting in only 4% of new fractures [ 96 ].…”

Endocrine disorders after heart transplantation: national cohort study

“…However, even greater reduction of fractures could likely be achieved with preoperative treatment when decreased BMD is present. In a more recent cohort of 105 HT patients, where antiresorptive treatment was initiated before solid organ transplant or immediately post-transplant, the incidence of VFs in the 1st year was 3.8% [46]. It is thus important to follow the guidelines of The International Society of Heart and Lung Transplantation guidelines for the care of HT recipients which recommend BP treatment for all HT recipients with decreased BMD within the first post-transplant year [47].…”