Osteoporosis and Lung Transplantation

Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

Annals of Saudi Medicine

Section: Specific Types Of Osteoporosismentioning

confidence: 96%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

“…There was a 5% reduction in BMD of both lumbar spine and femoral neck, which was associated with cumulative steroid dose after transplantation. In addition, 18% sustained osteoporotic fractures, despite vitamin D and calcium supplementation (30). Prospective studies have also demonstrated changes in bone mass and fractures incidence in patients who have received a lung transplant (29).…”

Section: Lung Transplantationmentioning

confidence: 99%

Bone disease after transplantation: osteoporosis and fractures risk

Borba

Arq Bras Endocrinol Metab

et al. 2014

Organ transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures. Arq Bras Endocrinol Metab. 2014;58(5):484-92Keywords Transplantation; bone loss; osteoporosis; fractures; immunosuppressive agents RESUMOTransplantes de órgão é terapia padrão-ouro para várias doenças em estágio terminal. Perda óssea é uma complicação comum que ocorre em pacientes transplantados. Osteoporose e fraturas por fragilidade são complicações sérias, principalmente no primeiro ano pós-transplante. Muitos fatores podem contribuir para patogênese da doença óssea nesses pacientes. Esta revisão aborda os mecanismos de perda óssea incluindo o papel dos agentes imunossupressores, bem como os fatores específicos da perda óssea após rim, pulmão, fígado, coração e transplante de medula óssea. A prevenção e o tratamento da perda óssea nos pacientes transplantados devem ser realizados para evitar fraturas. Arq Bras Endocrinol Metab. 2014;58(5):484-92 Descritores

“…Prospective studies have also demonstrated changes in bone mass and fracture incidence in patients who have received lung transplant (18)(19)(20). Bone loss rates at the lumbar spine and femoral neck range from 2% to 5% in the first year after lung transplantation (13,18).…”

Section: Lung Transplantationmentioning

confidence: 99%

“…Spira and cols. (19) evaluated BMD in 28 patients prior and 6 to 12 months post lung transplantation (19). All patients received calcium (1 g per day) and vitamin D (400 UI per day) after the transplantation.…”

Section: Lung Transplantationmentioning

confidence: 99%

Post-transplantation osteoporosis

Borba

Arq Bras Endocrinol Metab

et al. 2010

Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods including the contribution of immunosuppressive agents as well as the specific features of bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient will also be addressed.