Endocrine complications after solid-organ transplant in cystic fibrosis

Sidhaye, Aniket; Goldswieg, Bracha; Kaminski, Beth; Blackman, Scott M.; Kelly, Andrea

doi:10.1016/j.jcf.2019.08.019

Cited by 10 publications

(8 citation statements)

References 97 publications

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“…As discussed in detail in 'Transplantation' by Sidhaye et al [117], lung transplantation is associated with a high risk of low bone density and fractures, which can have a significant impact on patients' morbidity. Systemic glucocorticoid use is likely a key contributing factor in the bone loss occurring after lung transplantation and is well known in all patient populations to have a detrimental impact on bone.…”

Section: Special Case Scenarios: Lung Transplantation and Chronic Glucocorticoid Usementioning

confidence: 99%

Cystic fibrosis bone disease treatment: Current knowledge and future directions

Putman

Anabtawi

et al. 2019

Journal of Cystic Fibrosis

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Bone disease is a frequent complication in adolescents and adults with cystic fibrosis (CF). Early detection and monitoring of bone mineral density and multidisciplinary preventive care are necessary from childhood through adolescence to minimize CF-related bone disease (CFBD) in adult CF patients. Approaches to optimizing bone health include ensuring adequate nutrition, particularly intake of calcium and vitamins D and K, addressing other secondary causes of low bone density such as hypogonadism, encouraging weight bearing exercise, and avoiding bone toxic medications. Of the currently available anti-resorptive or anabolic osteoporosis medications, only bisphosphonates have been studied in individuals with CF. Future studies are needed to better understand the optimal approach for managing CFBD.

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Section: Special Case Scenarios: Lung Transplantation and Chronic Glucocorticoid Usementioning

confidence: 99%

Cystic fibrosis bone disease treatment: Current knowledge and future directions

Putman

Anabtawi

et al. 2019

Journal of Cystic Fibrosis

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“…Results were categorized as normal BMD ( T / Z ‐score greater than −1), at risk for progression to CF‐related low BMD (AR‐CFLBMD) ( T / Z ‐score between −1.0 and − 2.0), or CF‐related low BMD (CFLBMD) ( T / Z ‐score ≤ −2.0) according to current CFF and ECFS guidelines regarding low BMD treatment and follow‐up. ( 8 ) The ECFS labels T / Z ‐scores ≤ −2.0 in CF adults as “CFLBMD,” ( 19 ) but there is no standard nomenclature describing individuals with −1.0 > T / Z ‐score > −2.0. Therefore, we have termed this group “AR‐CFLBMD” to emphasize their risk of progression to CFLBMD.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors for Low Bone Mineral Density in Adults With Cystic Fibrosis

et al. 2022

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Single-center studies have suggested that up to 70% of adults with cystic fibrosis (CF) have lower than expected bone mineral density (BMD), substantially higher than the 25% prevalence reported from national registries. We determined the prevalence of low BMD in CF adults at our center and assessed risk factors for low BMD. This retrospective cohort study was conducted in all CF patients ≥18 years of age who had a dual-energy X-ray absorptiometry (DXA) scan performed at the Johns Hopkins Adult Cystic Fibrosis center between 2010 and 2018. Prevalence and incidence of low BMD during the study period were determined. Poisson regression based on generalized estimating equations and robust standard errors were used to evaluate selected risk factors and risk of disease progression. A total of 234 individuals underwent an initial DXA scan. At this scan, prevalence of low BMD was 52.6% (95% confidence interval [CI] 46.0-59.1). A total of 43.6% were at risk for CF-related low BMD (AR-CFLBMD) (95% CI 37.1-50.2) and 9.0% had CF-related low BMD (CFRLBMD) (95% CI 5.6-13.4). Of the 25 with normal BMD at initial scan and a subsequent follow-up scan, 8 (32.0%) progressed to AR-CFLBMD. Of the 53 with AR-CFLBMD on initial scan and a subsequent scan, 6 (11.3%) progressed to CFLBMD, 9 (17.0%) returned to normal BMD, and 38 (71.7%) remained AR-CFLBMD. Older age (relative risk [RR] = 1.01; 95% CI 1.00-1.01) and male sex (RR = 1.32; 95% CI 1.04-1.66) were associated with increased risk of low BMD, while higher forced expiratory volume over 1 second (FEV 1 %) predicted (RR = 0.99; 95% CI 0.99-1.00) and body mass index (BMI; RR = 0.97; 95% CI 0.94-1.00) were associated with lower risk for low BMD. The fact that more than half of all individuals were found to have lower than expected BMD suggests that the actual prevalence may be higher than currently reported in national registries. This supports the importance of universal bone health screening of all CF adults.

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“…Given the importance of maintaining glucose values in target range for transplant outcomes, CFRD screening with an OGTT is recommended in the 6 months prior to transplant 5 . Post‐transplant, immediate close bedside BGL monitoring is important, particularly given the increased risk of diabetes with glucocorticoids and other immunosuppressive agents 151,152 . It is recommended to verify elevations captured by SMBG with plasma glucose measurements.…”

Section: Screening For Cfrdmentioning

confidence: 99%